Exploring Facilitators and Barriers to Adherence to Evidence-Based Practice among Health Professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: A Qualitative Study

Exploring Facilitators and Barriers to Adherence to Evidence-Based Practice among Health Professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Facilitators and Barriers to Adherence to Evidence-Based Practice among Health Professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: A Qualitative Study Abigiya Zewde Biru, Trhas Tadesse Berhe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6925137/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Evidence-Based Medicine (EBM), first defined by Dr. David Sackett, is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Over time, the concept expanded to Evidence-Based Practice (EBP) to include all health professions, as outlined in the Sicily Statement, which also defines the necessary skills and educational qualifications to practice EBP effectively. Objective: To explore facilitators and barriers to adherence to Evidence-Based Practice (EBP) among health professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia. Method: A qualitative phenomenological study was conducted from April to August 2024. Data were collected through 27 Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with six healthcare professionals. Thematic analysis was employed to identify key themes, supported by triangulation, peer debriefing, and member checking to ensure reliability and validity. Results: Barriers to EBP adherence included administrative and systemic challenges, workforce issues, resistance to change, resource limitations, and infrastructure gaps. Facilitators included strong leadership, resource availability, accountability systems, and supportive environments. Effective implementation, monitoring, and quality improvement initiatives were also critical in promoting EBP. Conclusion: Addressing barriers and leveraging facilitators through a coordinated approach is essential to improving EBP adherence in routine healthcare. Barrier Barriers Facilitators Evidence-Based Practice Adherence Qualitative Study Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction 1.1 Background The two most often cited definitions of Evidence Based Medicine (EBM), which were first articulated by the late Dr. David Sackett, are as follows: “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patients”(1) ,which was later refined to “EBM is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values”(2) Evidence-based medicine, or EBM, is a method of providing healthcare in which general practitionersbase their clinical judgments on the best available evidence, or the most pertinent data, for each patient. Clinical skills, understanding of disease mechanisms and pathophysiology are all valued, enhanced, and expanded upon by EBP. It entails making intricate and careful decisions based on patient preferences, circumstances, and traits in addition to the evidence that is currently accessible. It acknowledges that health care is personalized, dynamic, and subject to both probability and uncertainty. In the end, evidence-based practice (EBM) is the formalization of the care process that generations of the best health care professionals have used. More thorough explanations of EBP have been released(3, 4) In recent years, a number of definitions of EBP have been proposed. In order to reflect a common approach to evidence-based practice (EBP) across all health professions, the Sicily Statement(5) proposed expanding the original term "evidence-based medicine" to "evidence-based practice," given that many health professionals have adopted an evidence-based way of practice.In addition to providing a precise definition of evidence-based practice (EBP), the Sicily Statement outlines the minimal educational and skill qualifications needed to practice EBP. This clarifies the fundamental procedures of EBP and creates a distinction between the process and the result of EBP(5). EBP has completely changed the way medicine is done during the last thirty years. Theoretically, its core principles—management based on the Best Current Evidence, patient values and expectations, and physician skills and expertise—remain unchanged. Its practical use in the age of information explosion has, however, undergone major changes. These changes include updated definitions, broader uses of the term EBM, and improved methods for recognizing the Best Current Evidence, advancements in research and clinical application, and EBM instruction(6). EBP is becoming more and more common across a variety of medical specialties. Its dependence on the collaboration of objective scientific data, clinical judgment, and unique patient requirements and preferences is one of its key characteristics. Because it's critical to locate and retrieve relevant literature from a variety of sources to aid in decision-making regarding medical care, librarians have a significant impact on the dissemination of evidence-based practice (EBP) (7) (Evidence is data/information from historical or scientific evaluations of procedures that can be utilized by healthcare industry decision-makers (8) The following five procedures comprise evidence-based practice: 1. Ask a question transforming the informational requirement into a question that can be answered, about things like therapy, diagnosis, prognosis, prevention, and causality. 2. Find information/evidence to answer question, searching for the most reliable information to address that query 3. Critically appraise the information/evidence, evaluating the evidence critically for its application (use in our clinical practice), impact (magnitude of the effect), and validity (closeness to the truth) 4. Integrate appraised evidence with own clinical expertise and patient’s preferences, combining the critical evaluation with our professional knowledge, our patients' particular biology, values, and circumstances, and 5. Evaluate, evaluating our effectiveness and efficiency in executing Steps 1-4 and seeking ways to improve them both for next time(9). EBP is the accepted and ideal standard for global trans-disciplinary healthcare providers, and it has the support of professional, national, and international healthcare organizations and regulatory bodies, including the National Academy of Medicine (NAM, 2022), the American Nurses Association (ANA, 2022), the Centers for Disease Control and Prevention (CDC, 2021), and the American Nurses Credentialing Center (ANCC, 2022). Reducing practice variability, improving patient outcomes, improving care quality, and lowering costs are the objectives of evidence-based decision-making (EBDM) (10). 1.2 Statement of the problems The amount of scientific knowledge that is now available to support medical professionals' clinical decision-making has increased dramatically in recent years. Despite the abundance of evidence, many healthcare systems in the US and around the world still do not implement evidence-based care because of cultural norms that keep people in their “comfort zones” and lack of competency in the EBP process among clinicians (11). Improving patient care outcomes within the framework of intricate healthcare systems is the aim of evidence-based practice, or EBP. However, the lack of daily consistency in the application of EBP by healthcare professionals makes it more difficult for healthcare organizations to provide high-quality, evidence-based care (12). A study called Effectiveness of Evidence-Based Practice Education on Emergency Nurses’ EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behaviour: A Randomized Controlled Trial, Six months after the course of study, the experimental group's results seemed to be best from the evaluated EBP educational intervention. Nevertheless, the outcomes for the majority of EBP locations started to decline after six months. The results were at the baseline level, or in some cases, significantly lower, by the 12-month measurement point (13). Knowledge, Attitude, and Practice towards Evidence-Based Medicine among Northern Saudi Primary Care Physicians: A Cross-Sectional Study Based on the PHC-based survey, we discovered that over half of the doctors had knowledge and attitudes about EBM that were either low or medium (14). Another study on Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice among Jordanian Nurses in Critical Care Units, EBP is influenced by a variety of factors, all of which fall under the responsibility of policy makers, administrators, physicians, researchers, and academics (15). Another study in Peru called Evidence-based practice among doctors in specialty training in a paediatric hospital, Nevertheless; paediatric specialists sometimes lack the time to look for scientific answers to the questions (16). Knowledge, attitude and use of evidence-based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey showed that despite having a good attitude toward EBP, they were not fully implementing it because of a few obstacles, such as a lack of time. Despite their awareness of evidence-based practice (EBP), this study suggests that they still need to improve their ability to locate and evaluate evidence in order to effectively advocate for EBP to their management, colleagues, and junior nurses and midwives (17). According to a study called The knowledge, attitudes, and practices of nurse educators regarding evidence-based practice at nursing education institutions in Lesotho, a significant portion of nurse educators at nursing education institutes in Lesotho lack EBP training, are unable to create targeted clinical questions to locate the required data, and do not use electronic databases (18). Health care professionals at public hospitals in the BunoBedele Zone and Illu Aba Bora generally practiced evidence-based medicine poorly (19). A study from North west Ethiopia showed that The majority of nurses did not fully utilize EBP (20) and another study from south Wollo zone indicate, Nursing professionals have a low level of adoption of evidence-based practice (21). A systematic review and meta-analysis Study called Determinants of evidence-based practice among health care professionals in Ethiopia showed that, it is necessary to increase the practice of utilizing the most recent research data in clinical decision-making for improved client care, as only around half (50%) of Ethiopian health professionals use evidence-based practice well (22). Therefore, the Purpose of this study will be to explore adherence, barriers and facilitators of evidence-based practice and its associated factors among health care professionals in Tirunesh Beijing General Hospitals, Addis Ababa, Ethiopia. 1.3 Social Cognitive Theory (SCT) Significance of the study Adherence to EBP is crucial in low- and middle-income country, like Ethiopia and throughout Africa, where the burden of disease is rising and there is a great need for EBP in clinical settings. In order to address the gaps in EBP adherence and remove barriers to EBP implementation, health institutions might make use of the information provided by this study. The study broadens the corpus of scientific information regarding the application of evidence-based health professional practice. Given its critical role in patient care, the study on the adherence of evidence-based practice (EBP) and associated factors by health professionals working in Tirunesh Beijing General Hospital is important to design a strategic way to improve patient care outcomes by enhancing the application of new best evidence from research findings to the health professionals in the health sector. Government and non-government organizations involved in this field can also use the findings to inform the development of action plans and measures. Furthermore, national policies that incorporate EBP can be developed using the study's findings and will guide health professionals' education by identifying the areas of focus to include in the curriculum and also will serve as a baseline for other researchers conducting additional research using other research designs. In particular, it enhances patient outcomes and lowers health care costs—a goal valued highly by funding and governmental organizations. Objectives 3.1 General objective To explore the facilitators and barriers influencing adherence to evidence-based practice among health professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia. 3.2 Specific objectives To examine the current practice with regard to Adherence of evidence-based practice among health professionals working at Tirunesh Beijing General hospitals Addis Ababa, Ethiopia, 2024 To explore barriers tothe adherence of evidence-based practice among health professionals working at Tirunesh Beijing General hospitals Addis Ababa, Ethiopia, 2024 To explore facilitators to the adherence of evidence base practice among health professionals working at Tirunesh Beijing General Hospital Addis Ababa, Ethiopia 2024 Methods 4.1 Study area and period. The study was conducted at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia, from April 22 to August 20, 2024. Tirunesh Beijing General Hospital, located in Addis Ababa, served as the primary focus of this research. The hospital employs a total of 723 healthcare professionals and plays a pivotal role in providing comprehensive healthcare services to the community. The diverse range of healthcare professionals includes 32 with a Master of Public Health (MPH), 64 midwives, 321 nurses, 57 doctors, 55 pharmacy professionals, 50 specialists, and 134 other health professionals. Additionally, the hospital includes 58 case team leaders from various health disciplines and is organized into 15 directorates. The hospital is equipped with modern facilities and technology, catering to both inpatient and outpatient services. With high patient volumes and extended hospital stays, Tirunesh Beijing General Hospital faces significant challenges typical of healthcare facilities in Ethiopia. These challenges include addressing the rising burden of disease, managing drug resistance, and ensuring the delivery of evidence-based healthcare practices. 4.2 Study design A qualitative phenomenological design was employed to explore the lived experiences and perceptions of health professionals regarding evidence-based practice. 4.3 Population 4.3.1 Source population The source population for this study was health professionals who worked at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. This included doctors, nurses, and other staff members involved in patient care or healthcare management within the hospital. 4.3.2 Study population The study participants consisted of a purposive sample of health professionals directly engaged in or possessing insights into evidence-based practice at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia. This sample encompassed individuals from diverse departments or specialties who had experience with implementation of evidence-based guidelines or protocols in their clinical practice. Participants included physicians, nurses, and pharmacists, who played active roles in healthcare delivery and decision-making processes related to evidence-based practice. 4.4 Eligibility Criteria 4.4.1 Inclusion criteria Health professionals directly employed by Tirunesh Beijing General Hospital. Individuals actively involved in patient care or healthcare management within the hospital. Participants with experience or involvement in evidence-based practice initiatives. Health professionals willing and able to participate in interviews or focus group discussions. Those capable of providing informed consent and participating meaningfully, regardless of language proficiency or other potential barriers Who are working at Tirunesh Beijing General hospitals in Addis Ababa, Ethiopia, 2024. 4.4.2 Exclusion criteria Health professionals not directly employed by Tirunesh Beijing General Hospital. Individuals who do not have any involvement in patient care or healthcare management. Participants who lack experience or involvement in evidence-based practice. Health professionals unwilling or unable to participate in interviews or focus group discussions. Those who are unable to provide informed consent or participate due to language barriers or other reasons that may hinder meaningful participation. 5.5 Sample size and Sampling technique /Sampling procedures For KIIs and Focus Group Discussions (FGDs) in this study, participants were selected from the source population based on their roles, experience, or involvement in evidence-based practice implementation or decision-making processes at the hospital. Key informants included department heads, quality improvement coordinators, quality officer and reform coordinators or individuals recognized for their expertise in evidence-based practice. Focus group discussions were conducted with groups of healthcare professionals from various departments to explore collective experiences, challenges, and facilitators related to the adherence to evidence-based practice. These participants provided valuable insights and perspectives through one-on-one interviews and group discussions. Details of the data collection methods and the study population are summarized in Table 1. Table 1: Summary of Data Collection Methods and Study Population Method of data collection Study population Number KII Department heads (Directorates) 5 Team leaders of various departments 4 Quality officers 3 Other individuals recognized for their expertise in evidence-based practice 15 Total 27 FGD Health professionals 2 Quality improvement coordinators 2 Reform coordinator 1 Research and 1 Total 6 5.6 Sampling Procedures: A total of 33 health professionals were selected from 723 health professionals at the hospital using purposive sampling. This method ensured the inclusion of individuals with specific expertise and roles relevant to the study's focus.For the Key Informant Interviews (KIIs), 27 participants were chosen, including 5 department heads (Directorates), 4 team leaders from various departments, 3 quality officers, and 15 other individuals recognized for their expertise in evidence-based practice. Additionally, 6 health professionals were selected for the Focus Group Discussion (FGD), which included 2 health professionals, 2 quality improvement coordinators, 1 reform coordinator, and 1 research professional.This sampling approach ensured the inclusion of individuals who could provide rich, detailed, and relevant insights into the research topics related to evidence-based practice. 5.7 Data Collection Procedures These participants were selected through purposive sampling to ensure that those with relevant knowledge and experience were included. Interviews were semi-structured, allowing for in-depth exploration of specific topics while providing flexibility to probe further based on participants' responses. The semi-structured interview and focus group discussion guides used in this study were developed by the research team specifically for this study based on constructs of the Social Cognitive Theory. The English versions of both guides have been uploaded as supplementary material (see Supplementary file 2.KII and FGD Guide). Each interview was conducted in a private setting to ensure confidentiality and was audio-recorded with the participants' consent. The recordings were transcribed, converting the spoken words into written text exactly as they were said for subsequent analysis. The FGDs involved 6 health professionals selected to represent a diverse range of perspectives within the healthcare setting. Participants were purposively sampled to include nurses, doctors, and allied health staff. The discussions were facilitated by a trained moderator using a guide to ensure consistency across groups while allowing for dynamic interaction and the emergence of new themes. FGDs were held in a neutral and comfortable environment, audio-recorded with consent, and transcribed for detailed analysis. Throughout the data collection process, the study adhered to ethical standards, ensuring informed consent, confidentiality, and the right to withdraw at any time. Data was continuously reviewed and analyzed using thematic analysis to identify patterns and insights that emerged from the interviews and discussions. This iterative approach helped refine data collection and analysis, ensuring the study captured comprehensive and meaningful information. 5.8 Data quality Assurance To ensure the quality of the data, significant attention was given to the design and translation of the data collection instruments. The data was collected through Key Informant Interviews (KII) and a Focus Group Discussion (FGD), both conducted via audio recording. The interview guides were initially prepared in English, as the study participants were health professionals, and later translated into Amharic to ensure clarity, simplicity, and validity. Before the actual data collection, a pre-test was conducted with 7 health professionals (20% of the 33 respondents) at Zewditu Memorial Hospital. This pre-test helped identify any issues with the interview guides and ensured their appropriateness for the study population. Feedback from the pre-test was used to refine and improve the guides. Key Informant Interviews (KII) were conducted with selected health professionals who were considered knowledgeable about the study topic. These interviews provided in-depth, expert insights, ensuring that the data collected was rich and informative. The KIIs were supplemented with the Focus Group Discussion (FGD), which enabled a more thorough examination of participants' viewpoints and experiences. In order to ensure that the sample was pertinent and representative of the target audience, participants for the KIIs and FGD were chosen based on their qualifications and experience. I personally collected the data, ensuring that both the KIIs and FGD were conducted in a consistent manner. I was careful to maintain confidentiality and ensure effective use of the audio recording equipment throughout the data collection process. The data was stored securely, and all recordings were transcribed and anonymized to maintain participant confidentiality. The reliability and validity of the interview guides were assessed after the pre-test with 7 health professionals. Any inconsistencies or issues identified during the pre-test were addressed, and necessary modifications were made to enhance the validity of the guides. Data saturation was monitored throughout the process, and data collection continued until no new information was emerging from the interviews or discussions. 5.9 Operational Definitions: Evidence-Based Practice (EBP) : Evidence-based practice is an approach to decision-making in which healthcare professionals integrate the best available research evidence, clinical expertise, and patient values and preferences to guide clinical practice. Barriers to EBP: Barriers to evidence-based practice refer to factors or obstacles that hinder the implementation or adoption of evidence-based approaches in clinical practice. These barriers can include organizational factors (e.g., lack of resources, time constraints), individual factors (e.g., lack of knowledge or skills in accessing and appraising research evidence), and contextual factors (e.g., resistance to change, organizational culture). Facilitators of EBP : Facilitators of evidence-based practice are factors or strategies that support and promote the implementation and adoption of evidence-based approaches in clinical practice. These facilitators can include organizational supports (e.g., access to resources, leadership support), educational interventions (e.g., training programs, continuing education), and professional networks (e.g., collaboration with colleagues, access to mentorship). Adherence to EBP : Adherence to evidence-based practice refers to the degree to which healthcare professionals follow or adhere to evidence-based guidelines, protocols, or recommendations in their clinical practice. It involves consistently applying research evidence and best practices to inform clinical decision-making, treatment planning, and patient care. 5.10 Trustworthiness of the Data In ensuring the trustworthiness of the data collected, several key strategies were implemented. First, to enhance credibility, member checking was conducted, allowing participants to review and validate the accuracy of their contributions. Additionally, an audit trail was maintained to establish dependability, documenting all steps of the research process for transparency and replicability. Confirmability was ensured through peer debriefing, involving external reviewers to verify the objectivity and neutrality of interpretations. Finally, to address transferability, a detailed description of the research context, participants, and methods was provided, allowing readers to assess the relevance and applicability of the findings to other similar settings or populations. These measures collectively upheld the integrity and reliability of the study's findings, fostering confidence in the insights gathered regarding evidence-based practice adherence within the healthcare context of Tirunesh Beijing Hospital. 5.11 Data Analysis Procedures The data were systematically analysed following established procedures. First, the audio recordings of interviews or focus group discussions were transcribed word for word, without any alterations or omissions, to ensure accuracy and completeness. The transcribed data were then organized and labelled systematically for easy reference during analysis. The data were familiarized by reading and re-reading the transcripts, making notes of initial impressions and recurring themes. ATLAS.ti version 9.1.3.0 was employed to identify and label meaningful segments of text, which were then grouped into broader categories or themes. Constant comparison was used to refine and elaborate on existing themes, while memos were written to capture reflections and insights throughout the analysis process. Peer debriefing and member checking were conducted to validate interpretations and ensure accuracy. Data saturation was assessed to determine if enough data had been collected to fully explore the research questions. Finally, the findings were synthesized and integrated into coherent narratives or theoretical frameworks, which were reported using rich, descriptive language in accordance with qualitative research reporting guidelines. 5.12 Ethical Consideration The Institutional Review Board (IRB) of Yekatit 12 Medical College, College of Public Health, and Department of Quality Health Care reviewed the protocol to ensure full protection of the rights of study subjects. Following approval by the IRB, an official letter of cooperation was sent to the Addis Ababa Regional Health Bureau from the Department of Quality Health Care of Yekatit 12 Medical College. After receiving permission from the Addis Ababa Regional Health Bureau, a letter of cooperation was sent to Tirunesh Beijing General Hospital. As the data collector, I was informed about the study after receiving approval from the hospital. Verbal and written informed consent were obtained from study subjects. Confidentiality was assured for all the information provided, and no personal identifiers (anonymity) were used on the questionnaires. 5.13 Dissemination of Results Results will be disseminated to Tirunesh Beijing General Hospital and Yekatit 12 Medical College, Department of Quality Health Care through documentation. To researchers and students, the results will be disseminated through presentations. If possible, it will be accessible on internet for all through publication. Result Socio-Demographic Characteristics of Participants A total of 33 participants were included in this study, comprising 27 from Key Informant Interviews (KIIs) and 6 from a Focus Group Discussion (FGD). The demographic data below represent all participants. Thematic results from the FGD are presented separately in Supplementary File 1 for clarity and space considerations . The majority of participants were male (78.8%), while females made up 21.2%. Most participants (75.7%) were aged between 31 and 40 years, with smaller proportions aged 20-30 years (18.1%) and 41-50 years (6%).Regarding educational status, a significant proportion (66.6%) of participants held a Master’s degree or higher, reflecting a highly educated cohort, while 33.3% held a Bachelor's degree. In terms of professional experience, 48.4% had 5-10 years of work experience, and 42.4% had more than 10 years, showcasing a wealth of expertise within the sample.Professionally, nurses and midwife with a Master’s in Public Health (MPH) were the largest group (27.2%), followed by specialists (24.2%), general practitioners (18.2%), and Pharmacists with advanced degrees (15.1%). Health officers, Laboratory technologists, Anaesthetists, and midwives were less represented, with each group accounting for 3-6% of the total sample. Participants held diverse roles, with 24.2% serving as team leaders and 15.1% in directorate positions, while the majority (60.6%) were classified under other roles, reflecting a broad range of professional responsibilities. The following table provides a detailed breakdown of the socio-demographic characteristics of all participants and is presented below as Table 2: Table 2: Socio-demographic characteristics of Key Informant Interview (KII) and Focus Group Discussion (FGD) participants Variable Category KII (n = 27) FGD (n = 6) Total (33) Gender Male 21 (77.7%) 5 (83.3%) 26 (78.8%) Female 6 (22.2%) 1 (16.6%) 7(21.2%) Profession Specialists 7 (25.9%) 1 (16.6%) 8 (24.2%) General Practitioners 6 (22.2%) 0 (0%) 6 (18.2%) MPH 6 (22.2%) 3 (5%) 9 (27.2%) Health Officers 2 (7.4%) 0 (0%) 2 (6.1%) Pharmacists (Master's in Pharmacy) 4 (14.8%) 1 (16.6%) 5 (15.1%) Laboratory Technologists (Master's) 1 (3.7%) 0 (0%) 1 (3%) Anaesthetist Master's) 0 (0%) 1 (16.6%) 1 (3%) Midwife 1 (3.7%) 0 (0%) 1 (3%) Role Directorate 5 (18.5%) 0 (0%) 5 (15.1%) Team Leader 5 (18.5%) 3 (5%) 8 (24.2%) Other 17 (62.9%) 3 (5%) 20 (60.6%) Educational status Degree 10 (37%) 1 (16.6%) 11 (33.3%) Master's and Above 17 (62.9%) 5 (83.3%) 22 (66.6%) Age group 20-30 years 6 (22.2%) 0 (0%) 6 (18.1%) 31-40 years 19 (70.3%) 6 (100%) 25 (75.7%) 41-50 years 2 (7.4%) 0 (0%) 2 (6%) Year of experience Less than 5 years 3 (11.1%) 0 (0%) 3 (9%) 5-10 years 15 (55.5%) 1 (16.6%) 16 (48.4%) More than 10 years 9 (33.3%) 5 (83.3%) 14 (42.4%) Notes: KII Participants (Key Informant Interviews): 26 individuals from various professions. FGD Participants (Focus Group Discussion): 6 individuals from different backgrounds 6.1. Results of Key Informant Interviews (KIIs) Theme 1: Understanding of Evidence-Based Practice (EBP) The majority of participants demonstrated a strong understanding of Evidence-Based Practice (EBP), highlighting its importance in improving patient outcomes, standardizing clinical practices, and integrating research evidence with clinical expertise. The key themes that emerged include the integration of research evidence into clinical decision-making, the adherence to established guidelines and protocols, and the consistent application of EBP across healthcare settings to enhance the quality of care (see Figure 2). Sub-theme 1.1: Definitions and personal interpretations of EBP Most respondents defined EBP as a structured approach to healthcare, integrating clinical expertise with the best available research to ensure practices are evidence-based and aligned with standardized protocols . This understanding underlines the goal of delivering high-quality, efficient treatment while adhering to established guidelines . As one respondent noted: “Evidence-based practice combines the best available research findings, such as opinion-based studies, cohort studies, and randomized controlled trials, with clinical experience.When guidelines are established based on these studies, they provide a framework for clinical decision-making.” (Respondent 15, 44:1 ¶ 32 ). Some participants emphasized that EBP bridges traditional practices and modern advancements by incorporating evolving knowledge into daily practice. For instance, many highlighted the transition from relying solely on physical examinations to utilizing advanced diagnostic tools, such as CT scans, as a significant improvement. One respondent shared: “In the past, we made all of our diagnosis and treatment decisions based only on physical examinations.Thanks to evidence-based practice (EBP), we can now use sophisticated instruments like CT scans, which facilitate quicker and easier diagnosis processes and enable us to act more rapidly.” (Respondent 2, 31:7 ¶ 41 ). Additionally, respondents stressed that EBP involves making treatment decisions supported by accurate, thoroughly researched, and reliable data. This ensures that clinical decisions are well-informed and tailored to improve patient outcomes. One participant elaborated: “When making treatment decisions for patients, medical professionals can use Evidence-Based Practice (EBP), which is the process of compiling evidence supported by many research.” (Respondent 1, 30:16 ¶ 32). Another respondent summarized the essence of EBP by highlighting its integration of research findings and clinical expertise: “It allows us to combine clinical expertise with the most recent research findings to make well-informed decisions.” (Respondent 2,31:1 ¶ 32). Sub-theme 1.2: General knowledge and awareness of EBP principles The responses reflected a strong awareness of Evidence-Based Practice (EBP) principles, with participants emphasizing the importance of basing clinical decisions on solid evidence rather than arbitrary judgments. Respondents highlighted the integration of technology with clinical data and patient history as essential for ensuring precision and alignment with best practices. For instance, one participant stated: “Through the integration of these technologies with clinical data and patient history, we guarantee that our actions are precise and in line with established best practices” (Respondent 2, 31:2 ¶ 32 ). The responses also highlighted that respondents are aware of the need to adapt EBP principles to new challenges , including integrating new technologies and guidelines into practice. Respondents acknowledged the importance of using evolving evidence and up-to-date research to enhance clinical decisions. For instance: “EBP assists us in adjusting to changing situations, workforce availability, and resource availability.” (Respondent 12, 50:41 ¶ 32 ). Respondents commonly recognized the necessity of adhering to high standards and rigorous quality controls when applying EBP. These principles were described as essential for ensuring that treatments align with best practices, as well as for ensuring that the evidence supporting them has been thoroughly analyzed. Many respondents also noted that maintaining up-to-date information is crucial for effective application. For example: Respondent 12 mentioned: “By referencing established quality standards, we align our practices with evidence-based guidelines, ensuring effective and reliable patient care” (Respondent 12,49:34 ¶ 32). There was a consensus among respondents regarding the importance of having a broad understanding of EBP principles. Most recognized that EBP is not static but requires adapting to changing circumstances such as shifts in guidelines, available resources, or evolving health conditions. One respondent mentioned how healthcare professionals must remain flexible in applying EBP: “EBP assists us in adapting to changing circumstances, such as fluctuating labor availability, resources, and circumstances.” (Respondent 13, 41 ¶ 32 ) Additionally, respondents pointed out the need for adhering to both international and local guidelines in clinical decision-making. However, they acknowledged the challenges of potential inconsistencies when different practitioners follow different guidelines. One respondent expressed concern over this issue: “If some practitioners adhere to U.S. guidelines while others follow national or regional guidelines, inconsistencies may arise in treatment protocols.” (Respondent 7, 36:44 ¶ 55 ) Sub-theme 1.3: Perceived importance of EBP in clinical practice Respondents strongly agreed on the perceived importance of Evidence-Based Practice (EBP) in clinical practice. The majority emphasized that EBP is not only integral to improving treatment outcomes but also crucial for enhancing patient care and ensuring optimal healthcare delivery . Respondent 7 noted that EBP’s integration of high-quality research into clinical practice is fundamental in improving care: “EBP enhances the quality of care and ensures continuous improvement in healthcare delivery” (Respondent 7, 36:27 ¶ 44). The perceived value of EBP was also expressed in terms of its role in adapting to evolving healthcare challenges . Respondents pointed out that staying current with evidence not only ensures better decision-making but also facilitates the application of new knowledge to address contemporary health issues. Respondent 12 elaborated on the role of EBP in adapting to medical advancements : “Adapting to the latest evidence and procedures because medical practice is continuously advancing” (Respondent 12, 50:17 ¶ 46). Moreover, the majority of the respondents linked EBP to the continuous improvement of healthcare interventions , noting that by relying on up-to-date evidence , clinicians can ensure that their practices remain effective and efficient . Respondent 6 highlighted the importance of applying reliable evidence : “In this globalized age, when people have access to a wealth of knowledge, I think it's essential to comprehend and use it wisely.” (Respondent 6,35:12 ¶ 43). The majority of respondents emphasized the essential role of Evidence-Based Practice (EBP) in healthcare delivery. Most of them highlighted that EBP is critical to clinical practice because it ensures that services and treatments are based on the best available evidence, which ultimately enhances the quality of care and patient outcomes. Respondents noted that continuous learning and the acquisition of practical skills are fundamental to successfully integrating EBP into clinical settings. A key point made was that having access to up-to-date information and staying informed through regular training opportunities were crucial for maintaining adherence to EBP (see Figure 3). For example, Respondent 6 stated: “Access to up-to-date information, continuous learning, and skill development are important factors that facilitate adherence to evidence-based practice at Tirunesh Beijing General Hospital.” (Respondent 6:) Theme 2: Strategies and Initiatives that Promote EBP In exploring successful strategies for promoting evidence-based practice (EBP), a common theme that emerged from the majority of participants focused on the establishment of clear protocols and guidelines, the integration of advanced technologies, and the creation of a culture that supports ongoing improvement and education. Below, we break down the findings under the following three sub-themes, highlighting the key points made by the respondents. Sub-theme 2.1: Establishing Clear Protocols and Guidelines to Promote EBP A prominent strategy discussed by respondents is the development and adherence to clear protocols and guidelines that standardize healthcare practices and ensure consistency in the delivery of care. Most respondents highlighted that structured and regularly updated guidelines contribute significantly to successful EBP adherence. For instance, Respondent 1 shared: “We have outlined the appropriate treatment for patients with specific conditions in our clearly defined scope of practice for physicians. This entails creating detailed protocols for every disease entity and making sure they are implemented in clinical settings.” (Respondent 1, 30:18 ¶ 36) This practice is particularly emphasized in departments like nursing, where creating and executing guidelines that promote evidence-based care is a focal point. Respondent 7 added: “Administratively, promoting EBP can be supported by clear guidelines and protocols that encourage adherence.” (Respondent 7, 36:12 ¶ 35) Sub-theme 2.2: Integration of Advanced Technologies and Tools to Support EBP Another vital strategy identified by the respondents is the integration of advanced technologies to facilitate and support EBP. This includes using evidence-based technologies to ensure the collection of accurate data and the application of best practices. Respondent 1 explained the use of technological integration: “These standards are developed through extensive trials, expert opinions, and the integration of these technologies with clinical data to enhance patient care.” (Respondent 3, 32:3 ¶ 32) Some respondents pointed to the integration of advanced diagnostic technologies and tools as a major factor in supporting EBP. They stressed that the use of cutting-edge tools such as CT scans, online databases, and diagnostic platforms enhances clinical decisions and patient outcomes. This combination of technology with clinical expertise forms the backbone of modern EBP approaches. “Integrating advanced diagnostic technologies like CT scans with clinical knowledge is one effective neurosurgical approach that supports evidence-based practice” (Respondent 2, 31:4 ¶ 36). Additionally, the implementation of international standards like ISO 15189 was recognized as crucial for maintaining high-quality practices, with Respondent 9 stating: “Implementing ISO 15189 standards have proven effective in ensuring quality results.” (Respondent 9: 49:37 ¶ 35) Lastly, EMR (Electronic Medical Recording) systems represent a key technological tool that supports EBP by making patient data more accessible, accurate, and consistent across different departments. The integration of EHRs enables healthcare providers to align their practices with the latest evidence and clinical guidelines by providing real-time access to patient histories, lab results, and treatment plans. This helps Equipping Staff to Maintain Standards “Ensuring that our team is well-informed and equipped to maintain these high standards is essential, especially when integrating new technologies such as EHRs.” (Respondent 9, ¶ 35) Sub-theme 2.3: Cultivating a Culture of Continuous Improvement and Education Respondents stressed the importance of creating a culture of continuous education and improvement as an essential factor for fostering EBP. Regular seminars, research discussions, and workshops help update healthcare professionals on the latest evidence, ensuring that practices remain current. Respondent 12 shared: Regular morning and seminar sessions, experience sharing, and discussions around evidence-based best practices help align our approach with the latest research.” (Respondent 12: 50:24 ¶ 49) The necessity of ongoing education and professional development to advance EBP was a recurrent subject among those surveyed. It was stated that creating a culture that promotes lifelong learning, skill improvement, and involvement in research is crucial. According to the respondents, cultivating such a culture improves healthcare professionals' capacity to apply EBP successfully and keeps them up to date on the most recent research. “Fostering a culture of continuous improvement in healthcare” (Respondent 9: 49:21 ¶ 45). Theme 3: Challenging Situations in adherence to EBP The majority of respondents identified various challenges in adherence to Evidence-Based Practice (EBP), focusing primarily on issues related to access to resources, resistance to change among staff, and workload challenges. These barriers significantly impact the adoption of EBP, leading to inconsistencies in patient care and hindering the effectiveness of clinical decision-making. Sub-theme 3.1: Access to evidence or resources Limited access to evidence or resources is a significant barrier to the effective implementation of EBP. Many healthcare professionals expressed difficulties in obtaining current and relevant research due to insufficient resources. Respondents emphasized the need for advanced tools and resources to support EBP, while also acknowledging the limitations in their availability. “The absence of sufficient diagnostic resources presents a major obstacle in implementing evidence-based practices” (Respondent 1:30:20 ¶ 40). “The availability of modern diagnostic equipment, especially MRI machines, is limited, affecting our ability to apply EBP efficiently” (Respondent 2: 31:18 ¶ 56). “There’s just not enough access to the latest studies; we often rely on outdated information because we can’t find the evidence we need.” “Improving the hospital’s system setup is crucial to support evidence-based practice effectively.” (Respondent:32:30 ¶ 68) Several respondents highlighted that limited access to resources and outdated diagnostic tools make it challenging to adhere to evidence-based practices (EBP). Issues such as equipment shortages, power outages, and insufficient staffing were recurrent themes. “The availability of resources is a key barrier to adhering to evidence-based practice, especially given budgetary constraints and economic issues.” (Respondent 2: 31:23 ¶ 64) “Frequent power outages disrupt EMR, limiting our ability to use EBP fully.” (Respondent 7: 35:20 ¶ 54) “Improving the hospital’s system setup is crucial to support evidence-based practice effectively.” (Respondent 3: 32:30 ¶ 68) Sub-theme 3.2: Resistance to change among staff Staff resistance to change was a recurrent theme. This resistance often results from a lack of knowledge about EBP principles, inadequate training, or a reluctance to embrace new practices that might interfere with long-standing habits. “I’ve been doing things this way for years; why change what seems to work?” (Respondent 5: 36:33 ¶ 50) “Without a unified policy or protocol from national policymakers, the variation in protocols between hospitals creates resistance among staff” (Respondent 15: ¶57). “Resource limitations, including insufficient training for staff, are a significant obstacle to consistent EBP implementation” (Respondent 14: ¶52). Resistance to adopting new practices was another key barrier. Many respondents noted that healthcare professionals often rely on previous experiences, creating reluctance to incorporate newer, evidence-based approaches. “Challenges arise when senior professionals rely solely on expert opinion, disregarding newer, evidence-based updates.” (Respondent 7, 36:18 ¶ 39) “We worked without clear direction—essentially, acting ‘without a clue,’ as staff were hesitant to embrace structured EBP methods.” (Respondent 9, 49:16 ¶ 38) “Resistance to change is often rooted in attitudes, which can hinder integration of new practices.” (Respondent 14, 36:40 ¶ 52) Sub-theme 3.3: Time constraints and workload challenges Time constraints and workload challenges significantly impede the integration of EBP. Healthcare professionals often cite heavy patient loads and competing responsibilities as barriers to engaging with EBP initiatives, leading to inconsistent application. “Applying Evidence-Based Practice (EBP) can be challenging due to variations in how it is implemented and the time needed for thorough application” (Respondent 3, ¶41). “There are instances where certain practices may not be feasible due to time constraints and the pressure of daily workloads” (Respondent 13, ¶49). “This neglect can lead to serious consequences for patient care, undermining the goals of EBP” (Respondent 9, ¶54). “I barely have time to see my patients, let alone look up new evidence or attend training sessions.”(Respondent 7) Sub-theme 3.4: Data Management and Decision-Making Challenges Proper data management was identified as a cornerstone of EBP, yet respondents cited difficulties with data collection, tracking, and decision-making. Inadequate monitoring of treatment outcomes, such as death rates in emergency rooms, led to less-informed decision-making. “One of the significant challenges in implementing EBP is improper data collection, which undermines the reliability of treatment decisions.” (Respondent 10, 51:17 ¶ 39) “We faced issues tracking sudden death rates due to inadequate data collection, affecting our ability to create effective indicators.” (Respondent 10: 51:35 ¶ 39) “Data-driven frameworks are essential for decision-making processes, yet they are often not fully established in practice.” (Respondent 15: 51:6 ¶ 32) Sub-theme 3.5: Quality and Outcomes Challenges Several respondents expressed concerns over the quality of evidence used in clinical settings. Distinguishing between high- and low-quality studies was mentioned as a challenge that could directly impact patient care outcomes. “The inability to differentiate between high- and low-quality studies creates further challenges, risking the application of poor-quality research.” (Respondent 7: 36:21 ¶ 39) “In settings where resource limitations are prevalent, implementing EBP can be difficult and may not yield the desired outcomes.” (Respondent 14: 43:8 ¶ 41) Theme 4: Success Stories in adherence to EBP Evidence-Based Practice (EBP) is recognized by respondents as a transformative approach that significantly improves patient outcomes and healthcare delivery. Respondents emphasized that EBP enhances clinical practices, reduces mortality rates, improves decision-making, and ensures consistent, error-free care. Sub-theme 4.1: Positive outcomes from EBP adherence (improved patient care, efficiency) Respondents highlighted that EBP has significantly improved patient care and efficiency in healthcare delivery. Effective adherence to EBP was reported to lead to better patient outcomes, streamlined processes, and overall enhanced quality of care. Respondents shared how EBP supports precise diagnoses, consistency in treatment, and resource efficiency: “Despite these challenges, EBP has been successful in transforming patient care and improving quality. When effectively adhered, EBP leads to better patient outcomes and enhanced healthcare delivery, demonstrating its value in advancing clinical practice.”(Respondent 3: 32:10 ¶42) “We have seen significant benefits from integrating EBP into our processes, leading to better patient care and enhanced decision-making.”(Respondent 9: 49:36 ¶ 40) “It is an essential part of providing efficient, quality healthcare.”(Respondent 1: 30:27 ¶ 46) “We guarantee more precise diagnoses and improved patient outcomes.”(Respondent 2: 31:13 ¶ 48) Respondents also shared specific examples: “Since we adopted evidence-based protocols, our patient care has significantly improved, leading to a noticeable reduction in complications” (Respondent 1). Another respondent emphasized the efficiency gained, stating, “Implementing EBP has streamlined our processes and helped us use resources more effectively, which ultimately benefits our patients” (Respondent 3). Sub-theme 4.2: I interdisciplinary collaboration Respondents noted that EBP fosters interdisciplinary teamwork, enabling healthcare professionals from various fields to collaborate effectively. This teamwork helps standardize care and integrate diverse perspectives, ultimately improving healthcare delivery. “Experience sharing and ongoing training play significant roles in implementing EBP across departments.” (Respondent 9) “Handled complex cases through experience sharing, showing that interdisciplinary support is essential for successful application.” (Respondent 12) Key Quote: “On the successful side, we’ve managed to handle complex cases through collaboration and discussion around evidence-based best practices” (Respondent 12), A positive attitude towards EBP was also seen as crucial for fostering interdisciplinary collaboration. “Therefore, fostering a positive attitude towards EBP is essential for enhancing interdisciplinary collaboration.”(Respondent 9: 49:1 ¶ 54) “An open and adaptive attitude towards EBP is crucial for effectively integrating interdisciplinary collaboration.”(Respondent 3: 32:25 ¶ 63) “Ultimately, evidence-based practice is a matter of life and death, guiding healthcare professionals in their interdisciplinary roles to provide better care.”(Respondent 13: 42:14 ¶43) Specific examples highlighted the benefits of collaboration: “Working together as a team—doctors, nurses, and pharmacists—has allowed us to integrate various perspectives and improve our care plans” (Respondent 2). “Our interdisciplinary meetings have fostered better communication and teamwork, which have been crucial for applying the best available evidence in patient care” (Respondent 4). Sub-theme 4.3: Decision-making through EBP Respondents agreed that EBP enhances healthcare decision-making by providing thoroughly researched, evidence-based guidelines. This approach minimizes reliance on outdated methods or intuition, resulting in more precise and efficient clinical decisions. “EBP allows us to improve the quality of our services, leading to better patient care and enhanced decision-making.” Respondent 9 (49:13 ¶ 40) “Regularly conducting clinical audits to evaluate adherence to evidence-based practice ensures better decision-making and patient outcomes.” Respondent 14 (43:5 ¶ 37) “We guarantee more precise diagnoses and improved patient outcomes, which result from better clinical decision-making based on EBP.” Respondent 2 (31:5 ¶ 36) Respondents highlighted the reduction of variability and adherence to clinical guidelines as key benefits. “With EBP, we rely on high-quality research rather than just our experience, which has improved the effectiveness of our interventions” (Respondent 5). “The shift towards evidence-based decision-making has reduced variability in our practices and improved adherence to clinical guidelines” (Respondent 6). Moreover, EBP was recognized as critical for patient safety and quality improvement: “Guidelines create opportunities for effective treatment,” emphasizing that evidence-based decision-making directly impacts patient outcomes. (Respondent 13) “Ultimately, evidence-based practice is a matter of life and death, guiding us to make the best possible choices for patient care” (Respondent 13). Theme 5: Factors Facilitating Adherence to EBP Adherence to Evidence-Based Practice (EBP) is driven by factors such as resource availability, leadership support, and continuous training. These elements create an environment where healthcare professionals can consistently apply updated knowledge in their practice. Institutional backing, professional development opportunities, and individual motivation were highlighted as critical drivers for sustained adherence and meaningful improvements in clinical care. Sub-theme 5.1: Availability of training and professional development Continuous professional development (CPD) emerged as a crucial factor in maintaining adherence to EBP. Respondents frequently cited the importance of specialized training sessions, workshops, and bedside audits to reinforce EBP principles. CPD opportunities ensure healthcare staff stay informed about the latest EBP guidelines and practices, creating a foundation for effective implementation. “Providing continuous professional development (CPD) training for clinical staff, ensuring they stay updated with EBP principles.” (Respondent 3, ¶37) Training opportunities such as clinical audits, morning sessions and rounds activities help ensure that healthcare staff stay informed about the latest EBP guidelines and practices. “Conducting clinical audits and reviewing patient charts help ensure that practices are aligned with EBP guidelines.” (Respondent 3, ¶ 51) Regular updates, such as interdisciplinary rounds and the sharing of new guidelines, also play a significant role. Respondents noted that multidisciplinary approaches create enriched learning environments that foster collaboration and reinforce adherence to EBP. “We share and normalize updated guidelines that we’ve developed in clinical rounds, helping staff stay current with EBP standards.” (Respondent 12, ¶ 35) “Multidisciplinary approach strengthens adherence to evidence-based practices across departments.” (Respondent 12, ¶ 49) Sub-theme 5.2: Institutional support (leadership, resources) Strong institutional support was repeatedly identified as essential for EBP adherence. Leadership commitment, resource provision, and fostering a culture of accountability were highlighted as critical components. Respondents noted that effective leaders set positive examples, allocate necessary resources, and create an environment conducive to evidence-based practices. For instance, the Ministry of Health's initiatives, such as SBFR and EHAQ, provide structured guidance and resources to sustain EBP. Hospital administrators also play a vital role by ensuring the availability of essential medical devices, even amidst resource shortages. “The Ministry of Health's initiatives, like the SBFR, EHAQ, and EBC programs, offer great assistance and direction… guaranteeing that EBP will continue to be developed and implemented.” (Respondent 1, ¶49) “The management is responsible for assuring the supply of vital medical devices, which are frequently unavailable, and understands their importance.” (Respondent 2, ¶52) A culture of engaged leadership and collaboration encourages accountability and ensures that resources and support systems are consistently available to maintain high EBP standards. “Encourage leaders at all levels to champion EBP initiatives, ensuring that they allocate resources and support necessary for successful implementation.” (Respondent 10, ¶ 95) “The administrative side also plays an important role by supporting these efforts.” (Respondent 15, ¶ 46) Sub-theme 5.3: Individual motivation and commitment to EBP Individual commitment and motivation are critical to integrating EBP into daily practice. A supportive environment that empowers and recognizes healthcare professionals was noted as a key factor in promoting adherence to EBP. Respondents emphasized that personal dedication to EBP enhances patient care, job satisfaction, and proactive engagement with evidence-based decisions. “When healthcare professionals collectively accept the significance of such evidence, it encourages a proactive approach to data management.” (Respondent 10, ¶76) “The success of evidence-based practice (EBP) is clear in how it helps transform patient care and achieves favourable outcomes.” (Respondent 6, ¶ 38) A collaborative culture where evidence is created and shared reinforces individual commitment to EBP. Respondents highlighted the role of senior staff in championing EBP and inspiring broader adherence across departments (see Figure 4). “Active involvement of senior staff in promoting and practicing EBP encourages broader adherence and integration throughout the hospital.” (Respondent 3, ¶ 54) “Encourages staff to actively engage in evidence creation and application.” (Respondent 12, ¶ 49) Theme 6: Challenges and Barriers to adherence to EBP Adherence to Evidence-Based Practice (EBP) faces numerous challenges that hinder its full integration into healthcare settings. These barriers exist at individual, institutional, and systemic levels, limiting the consistent application of EBP principles in clinical practice. Sub-theme 6.1: Individual-level barriers (lack of knowledge, negative attitudes) Individual-level barriers such as knowledge gaps, resistance to change, and negative attitudes significantly hinder the adherence to Evidence-Based Practice (EBP) among healthcare professionals. Many practitioners lack a thorough understanding of EBP or perceive it as an additional burden rather than an integral aspect of their responsibilities. These barriers are further compounded by ingrained habits and insufficient motivation. Knowledge Gaps and Resistance to Change Several respondents emphasized the lack of adequate education and awareness about EBP as a primary challenge. Some practitioners do not perceive gathering and utilizing evidence as part of their clinical duties, leading to inconsistent application. For instance, one respondent noted: “If healthcare professionals do not view gathering and using information as part of their work, they may be less inclined to adopt EBP in their clinical practice” (Respondent 6, 35:24). Reliance on traditional practices and expert opinions was also highlighted as a barrier: Reliance on expert opinion can also be problematic” (Respondent 7, 36:38). Without adequate knowledge and training, healthcare professionals struggle to integrate EBP into their routines, viewing it as an optional rather than essential component of patient care. Negative Attitudes and Lack of Motivation Negative attitudes towards EBP were another recurring theme. Many practitioners resist change, often due to a perception that EBP disrupts established workflows or adds to their workload. As one respondent shared: “Some staff may not prioritize EBP, seeing it as less important than other daily duties” (Respondent 6, ¶55). This resistance is exacerbated by a lack of encouragement and support from leadership: “Without adequate motivation and encouragement from leadership, health professionals may struggle to engage with EBP initiatives” (Respondent 6, ¶56). A positive attitude was noted as a key enabler of EBP adoption. However, in its absence, ingrained habits and skepticism towards new practices impede progress: “A positive attitude toward EBP makes its adoption smoother, but without it, professionals may resist” (Respondent 7). Administrative Challenges and Systemic Impacts Respondents also pointed out that administrative resistance to new information could hinder the integration of EBP into clinical settings: “Administrative acceptance of new information is one of the biggest challenges health professionals faces when implementing EBP" (Respondent 7, 36:33 ¶50). “This attitude can hinder the integration of new practices and make it more difficult for EBP to become fully embedded in clinical settings” (Respondent 7, 36:40 ¶52). These challenges are further illustrated in Figure 5 , which presents a network analysis of administrative and systemic barriers to EBP adherence. Sub-theme 6.2: Institutional barriers (lack of infrastructure, funding) Institutional barriers such as inadequate infrastructure, insufficient funding, and limited organizational support were frequently cited by respondents as significant challenges to implementing Evidence-Based Practice (EBP). These systemic issues hinder healthcare professionals’ ability to consistently adopt evidence-based approaches, affecting both the quality and efficiency of care delivery. Infrastructure Limitations Inadequate infrastructure, including limited access to diagnostic tools, internet connectivity, and physical resources, emerged as a prominent barrier. Respondents highlighted the unavailability of essential diagnostic equipment and modern technologies as a significant hindrance to EBP implementation: “The absence of sufficient diagnostic resources presents a major obstacle to the implementation of evidence-based practice (EBP)” (Respondent 1, 30:20 ¶40). “The availability of modern diagnostic equipment, especially MRI machines, presents a significant barrier for medical professionals practicing evidence-based practice” (Respondent 2, 31:18 ¶56). Access to updated guidelines is another critical issue. Without internet connectivity or hard copies of guidelines, healthcare professionals struggle to stay informed about best practices: “The absence of hard copies further emphasizes the need for internet connectivity” (Respondent 12, ¶52). Infrastructure challenges extend to incomplete data management systems, which impede decision-making: “Data compilation is vital for decision-making, but incomplete registration and lack of infrastructure impair this process” (Respondent 10, ¶68). Financial Constraints Budget limitations were widely reported as a critical barrier to EBP. These constraints impact the procurement of diagnostic tools, implementation of training programs, and hiring of adequate staff: “Budget constraints can also pose a significant barrier” (Respondent 12, 51:30 ¶70). Additionally, insufficient funding hampers the ability to maintain or upgrade infrastructure, further compounding the challenges faced by healthcare providers. Workforce Challenges Heavy workloads and inadequate staff-to-patient ratios were frequently cited as obstacles to prioritizing EBP. High demands on healthcare professionals limit their time and capacity to engage in evidence-based practices: “Inadequate staff-to-patient ratios and heavy workloads make it challenging to prioritize EBP” (Respondent 4). A lack of ongoing training exacerbates the issue. Without continuous education and skill development, healthcare professionals struggle to stay updated on evidence-based guidelines: “Insufficient ongoing training can impede the effective application of EBP, as healthcare professionals need continuous education to stay updated with best practices” (Respondent 3). Organizational and Leadership Gaps Respondents also identified limited organizational support as a key barrier. Poor incentives, lack of recognition, and minimal accountability diminish motivation to adopt EBP: “Incentives, acknowledgment, and accountability are lacking, which may have a negative effect on engagement and motivation” (Respondent 1: ). Sub-theme 6.3: Cultural or systemic resistance to change Resistance to adopting Evidence-Based Practice (EBP) is often rooted in both cultural and systemic factors, creating significant barriers to its implementation. These challenges stem from deeply ingrained beliefs, traditional practices, and organizational inconsistencies that hinder the seamless integration of evidence-based approaches. Cultural Resistance to Change Cultural norms and attitudes within healthcare institutions significantly influence EBP adoption. Respondents emphasized that longstanding reliance on traditional practices, particularly among senior professionals, creates resistance to updating care methods: “Resistance to change is a significant obstacle, as implementing EBP necessitates modifying long-standing practices” (Respondent 1). “Senior professionals may sometimes believe that their experience outweighs the importance of current evidence” (Respondent 7). “There is a tendency among professionals to adhere to traditional practices rather than adopting new evidence-based approaches” (Respondent 3). This cultural reluctance is further complicated by differences in local practices compared to global standards. Such cultural resistance delays the acceptance of EBP, particularly in settings where traditional practices are valued over emerging evidence. For example: “The treatments or guidelines used in places like America might not align with our system” (Respondent 15, 44:24). Systemic Barriers Systemic challenges, including inconsistent policies, frequent management changes, and a lack of standardized guidelines, further impede EBP implementation. Respondents highlighted the absence of a unified framework for information exchange as a critical barrier: “Without a unified policy or protocol from national policymakers, the variations in information exchange among institutions can lead to inconsistencies in care” (Respondent 15, 44:32 ¶57). “Additionally, with changes in management, the updating of standard treatment protocols is often delayed” (Respondent 13, 42:26). Frequent shifts in leadership disrupt continuity, making it challenging to sustain EBP initiatives. Moreover, inconsistent policies across institutions create confusion and hinder the alignment of practices with evidence-based guidelines. Interplay Between Cultural and Systemic Barriers Cultural and systemic resistance often interact, amplifying the challenges to EBP adoption. For instance, the reluctance of senior staff to embrace change may discourage management from enforcing updated protocols, further delaying EBP integration. Similarly, systemic delays in providing clear guidelines can reinforce reliance on traditional practices, creating a cycle of stagnation. These overlapping challenges are illustrated in Figure 6 , which presents a summary of barriers to adherence to Evidence-Based Practice. Theme 7: Recommendations for Improving EBP Adherence Sub-theme 7.1: Suggestions for better training and education Respondents emphasized the importance of continuous training and education to keep healthcare professionals updated on the latest evidence-based practices (EBP). Rapid advancements in medicine necessitate ongoing learning to avoid reliance on outdated practices. Respondent 2 highlighted this by stating: "Given how quickly medicine is evolving, it's important to acknowledge that procedures performed ten years ago might not be applicable today. To align with EBP, we need to constantly update our knowledge and procedures." Respondents recommended holding frequent, focused training sessions to help close the gap between theoretical understanding and real-world application. These were considered essential for fostering competence and self-assurance in medical personnel. Important findings include: "Changing attitudes and enhancing knowledge through regular updates and training can improve adherence to EBP" (Respondent 3, ¶52). "Ongoing awareness and education are essential; regular training sessions keep staff informed about the latest practices" (Respondent 4, ¶46). "Providing practical training opportunities allows healthcare professionals to apply EBP principles in real time" (Respondent 6, ¶47). Practical recommendations included expanding training on digital literacy, improving access to EBP resources, and facilitating peer-to-peer learning. For instance, Respondent 6 noted: "Facilitating experience exchange among professionals supports the effective implementation of EBP." Respondents also emphasized the importance of collaborative forums, such as seminars and annual meetings, to promote a culture of continuous learning. Respondent 12 suggested: "Promoting collaboration through seminars, meetings, and shared journals can establish a culture of continuous improvement." However, a lack of digital proficiency among staff was identified as a barrier to accessing and utilizing EBP resources effectively. Respondent 6 explained: "A lack of proficiency in computer use and software applications prevents staff from accessing and utilizing electronic resources." Developing competence and confidence in clinical decision-making through EBP was seen as a cornerstone of improving patient care. Respondents noted: "Understanding the importance of EBP ensures that clinical decisions are based on the most recent research" (Respondent 1, ¶55). "A positive attitude toward EBP is crucial for effective clinical decision-making" (Respondent 4, ¶52). Sub-theme 7.2: Need for policy changes or updated guidelines Many respondents called for updated organizational policies and standardized guidelines that integrate current evidence into routine care. They stressed the importance of aligning national and institutional protocols to improve adherence to EBP. Respondent 1 recommended: "Effective implementation of initiatives like Ethiopian Hospital Alliance for Quality (EHAQ) and Evidence-Based Care (EBC) is crucial to increase adherence to EBP." Clear and regularly updated policies were seen as essential for maintaining consistency in practice. Respondent 14 suggested: "Encouraging healthcare professionals to read and understand guidelines, such as the Ethiopian Hospital Service Improvement Guideline (EHSIG) and EBC protocols, enhances knowledge and commitment to EBP." Respondents also identified the need for a centralized platform to provide easy access to updated guidelines, research publications, and protocols. For example: "To achieve a standardized national framework, collaboration among healthcare stakeholders is vital to create comprehensive and evidence-based guidelines" (Respondent 15, ¶44:33). "Providing easy access to journals and research publications empowers health professionals to stay informed and engaged with EBP" (Respondent 15, ¶44:41). The lack of accessible platforms for obtaining manuals and guidelines was seen as a significant barrier. Respondent 13 noted: "There is a lack of accessible platforms for obtaining manuals at every location." Additionally, respondents suggested tailoring national guidelines to local needs by incorporating hospital-specific quality improvement (QI) projects. Respondent 1 explained: "By adding hospital-specific QI projects to national guidelines, we have successfully created and executed local protocols." Respondents emphasized that frequent updates to policies and guidelines are necessary to keep pace with changes in evidence and practice. Respondent 13 remarked: "If changes occur frequently or rapidly, prompt updates are essential." Sub-theme 7.3: Recommendations for improving leadership and support systems One of the most important suggestions for developing an Evidence-Based Practice (EBP) culture was to improve organizational support and leadership. The necessity of mentorship, active training engagement, and leadership that values cooperation and knowledge exchange was often emphasized by respondents. It was believed that leaders play a key role in fostering an atmosphere that supports EBP and inspires staff members to pursue ongoing education and skill improvement. Promoting a Culture of Learning and Collaboration Leadership was frequently described as the cornerstone for establishing a culture of continuous learning. Respondents emphasized the importance of fostering teamwork, open communication, and ongoing development. Leaders are expected to encourage health professionals to adapt to advancements in healthcare practices and actively support EBP adherence. “Fostering an environment that prioritizes continuous learning and adaptation” is vital to make EBP more engaging and practical (Respondent 7: ¶36:54). “Health professionals must cultivate patience and a willingness to share their EBP knowledge with colleagues,” underscoring the role of leaders in building a collaborative environment (Respondent 14: ¶43:22). Respondent 9 advocated for “Fostering a culture of continuous improvement in healthcare” as a sustainable approach to integrating EBP into everyday practice (Respondent 9: ¶49:21). Leadership-Driven Support Systems The active involvement of leaders in implementing and sustaining EBP was recognized as fundamental. Respondents recommended establishing dedicated teams to regularly update guidelines and disseminate information effectively. They also stressed the importance of utilizing communication tools to enhance the accessibility of EBP resources. “The hospital effectively motivates adherence to evidence-based practice (EBP) by utilizing its own communication system to disseminate new information via platforms like Telegram,” noted Respondent 13 (¶42:15). “To ensure timely updates, there should be a dedicated team responsible for this task,” added Respondent 13 (¶42:27). Addressing Systemic Challenges Several respondents pointed out systemic barriers, such as resource constraints, excessive workloads, and outdated systems, that hinder healthcare professionals’ ability to implement EBP effectively. Leadership was seen as crucial in addressing these challenges to create an enabling environment for evidence-based care. Respondent 4 recommended addressing staffing levels, stating, “Improving the nurse-to-patient ratio allows healthcare professionals to focus more on implementing EBP without being overwhelmed by excessive workloads” (¶69). Respondent 3 highlighted the need for better system design, suggesting that hospitals must have “Functional and user-friendly systems that facilitate evidence-based care” (¶79). Respondent 3 further emphasized overcoming resource constraints, stating, “Address and overcome resource constraints to ensure that necessary tools and support are available for effective EBP implementation” (¶78). Mentorship and Knowledge Sharing Respondents highlighted the importance of mentorship programs and professional experience exchanges to reinforce EBP principles. Leadership was urged to prioritize mentorship as a means of improving staff confidence and competence in EBP application. “Learning about these developments is crucial as traditional medicine moves toward evidence-based practice,” noted Respondent 2, emphasizing the role of leaders in bridging the knowledge gap (¶36:12). Respondent 12 suggested that fostering collaboration among professionals through “seminars, annual meetings, and forums for sharing journals and publications ” Could promote a culture of continuous learning and improvement (¶50:32). Discussion This study explored the facilitators and barriers to adherence to evidence-based practice (EBP) among healthcare professionals at Tirunesh Beijing Hospital. The findings revealed a variety of interconnected factors that either promote or hinder the effective implementation of EBP within this healthcare setting. Healthcare professionals identified several key facilitators and motivators that support their adherence to EBP in clinical practice. They also highlighted various barriers that impede EBP adherence, both at the individual and institutional levels. Key factors influencing the success or challenges of EBP adoption included the availability of training, institutional support, personal motivation, and a collaborative environment. These elements were discussed as critical to understanding the factors that facilitate or obstruct adherence to EBP among healthcare professionals in the hospital. One of the critical facilitators identified in this study is the availability of continuous professional development (CPD) and structured training for healthcare staff. The importance of CPD in keeping healthcare professionals updated with the latest EBP principles is well-documented in the literature. Respondents emphasized that regular training and clinical audits, along with sharing updated guidelines during clinical rounds, are essential strategies for ensuring that practices remain aligned with EBP standards. This is supported by literature that highlights the need for EBP experts, online support guides, and ongoing communication as facilitators of EBP (Literature ( 24 , 26 , 28 ). For instance, structured discussions and the availability of electronic education modules have been identified as important for promoting EBP, particularly in stroke rehabilitation and long-term care settings ( 24 , 26 ). Institutional support, including leadership involvement, resource availability, and structured support systems, plays a vital role in the successful implementation of EBP. In this study, participants highlighted the importance of management’s role in providing vital medical devices and ensuring that these resources are available to support EBP initiatives. This finding aligns with the literature, which emphasizes the significance of management support in creating a culture conducive to EBP. The availability of resources and strong leadership have been identified as crucial facilitators in various studies, including those focused on long-term care( 26 ), stroke rehabilitation( 24 ), and healthcare professional views on barriers and facilitators to EBP ( 28 ). The role of executive sponsorship and a strong governance framework also supports EBP implementation, as seen in Australian healthcare systems ( 29 ). Individual motivation and commitment are essential for the success of EBP. Participants in this study described the proactive approach that healthcare professionals take when they collectively recognize the importance of evidence in patient care. This observation is consistent with the literature, which highlights the significance of individual attitudes, self-efficacy, and the role of healthcare professionals' motivation in promoting EBP( 27 , 32 ). For example, healthcare professionals who are motivated and committed to applying evidence to improve patient care are more likely to engage in knowledge-sharing practices and promote evidence-based interventions. Similarly, a collaborative approach fosters a culture of learning, contributing to the transformation of patient care and improved outcomes ( 27 ). A collaborative environment is another key facilitator identified in this study. The findings suggest that knowledge sharing and collaboration among healthcare professionals, especially through interdisciplinary teams, are vital in translating evidence into practice. Literature also supports this view, as it emphasizes the role of collaborative culture and team-based approaches in the successful implementation of EBP ( 25 , 26 , 34 ). In particular, fostering a positive atmosphere and involving senior staff in promoting EBP has been shown to encourage broader adherence across healthcare settings (Literature 25, 29). Furthermore, the importance of relationship-building and ongoing communication within teams has been noted as essential for maintaining a collaborative approach to EBP (Literature ( 24 , 25 ). One of the major individual-level barriers to adopting EBP is the lack of knowledge among healthcare professionals, which prevents the effective application of evidence-based guidelines. Literature highlights this challenge, citing insufficient knowledge and understanding of evidence-based practices as critical issues. For instance, healthcare workers often lack familiarity with clinical guidelines and rely heavily on traditional practices ( 28 , 33 ). Negative attitudes toward EBP further exacerbate the problem, leading to resistance to change. Senior staff are particularly resistant, perceiving EBP as irrelevant to daily practice ( 24 , 27 ). Additionally, lack of motivation, often driven by poor leadership support, compounds this resistance ( 25 , 30 ). Institutional barriers such as inadequate resources, limited funding, and lack of infrastructure also hinder EBP adoption. Studies consistently emphasize how resource shortages—whether in diagnostic tools, technology, or financial investments—impede the implementation of evidence-based guidelines ( 24 , 30 , 38 ). Furthermore, insufficient incentives and recognition for engaging in EBP contribute to disengagement among healthcare professionals, especially when paired with high workloads and inadequate staffing ( 26 , 35 ). A lack of continuous training is another significant challenge. Many healthcare institutions fail to provide adequate educational programs, leaving professionals ill-equipped to implement updated guidelines( 32 , 35 ). Cultural and systemic barriers also play a major role. Traditional practices and hierarchical beliefs often dominate clinical decision-making, creating resistance to EBP, especially in low-resource settings (Literature ( 33 , 35 ). Senior professionals frequently prioritize personal judgment over research-based guidelines, perpetuating resistance( 34 ). Finally, systemic barriers such as inconsistent policies and lack of standardized guidelines disrupt EBP integration. Frequent leadership changes and policy misalignments create confusion, as noted in Ethiopian studies where imported practices failed to align with localhealthcare contexts ( 40 – 42 ). Conclusion This study explored the facilitators and barriers influencing adherence to evidence-based practice (EBP) among health professionals at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. Through a qualitative phenomenological approach, insights from key informant interviews (KIIs) and focus group discussions (FGDs) revealed a comprehensive understanding of EBP adherence in this setting. The findings highlight that adherence to EBP is fostered by several key facilitators, including resource availability, collaboration and knowledge-sharing among professionals, and a collaborative culture that supports EBP. Development of protocols and guidelines, as well as education and capacity-building initiatives, further encourage professionals to integrate evidence-based guidelines into their daily practice. Additional factors like structured EBP frameworks, regular clinical audits, and timely updates enhance health professionals’ confidence in applying EBP. Moreover, support from institutional leaders, advocacy for EBP, and incentives for motivation create an environment that promotes a culture of EBP and positively impacts patient outcomes.However, there are certain barriers that make it difficult to adhere to EBP. Heavy workloads, inadequate staff-to-patient ratios, and frequent administrative resistance lead to high levels of busyness and hinder EBP integration. Practical limitations, such as insufficient diagnostic equipment, lack of computer skills, and power cuts affecting electronic medical records (EMR), further obstruct consistent EBP implementation. Attitudinal barriers, including resistance to change, lack of interest, and reliance on expert opinion over research-based guidelines, also diminish adherence. Additionally, resource constraints, limited training opportunities, and issues with hospital system compatibility complicate the routine application of EBP. This study underscores the need for a strategic approach to strengthen EBP adherence. Addressing these barriers through enhanced resource allocation, structured EBP frameworks, and regular professional training could significantly improve EBP integration. By cultivating a supportive institutional culture and minimizing administrative obstacles, healthcare facilities can create a more consistent application of evidence-based practices, ultimately enhancing patient outcomes and care quality. Future research should investigate targeted interventions for specific barriers, measure their impact, and explore the broader effects of EBP on healthcare delivery and patient satisfaction in similar settings. Limitation and strength Limitations Limited Generalizability: Since the study was conducted in a single hospital, the findings may have limited generalizability to other healthcare settings. Differences in institutional policies, resources, and staff composition in other hospitals may affect EBP adherence differently. Sample Size Constraints: Although the sample size of 27 for KIIs and 6 for FGDs was appropriate for a phenomenological study, a larger sample across multiple departments could have provided additional perspectives. This limitation may restrict the depth of insights into department-specific barriers and facilitators of EBP adherence. Potential for Researcher Bias: As with many qualitative studies, the interpretative nature of phenomenological analysis may introduce some degree of researcher bias. While ATLAS.ti helped in organizing data, the analysis relied on subjective interpretations that could influence the findings. Context-Specific Challenges in Data Collection: Conducting the study within the hospital setting presented logistical challenges, such as scheduling interviews with busy healthcare professionals, which may have limited the availability of some participants or influenced the depth of discussions in time-constrained sessions. Technology-Related Constraints: Although ATLAS.ti facilitated data management, the software's limitations in certain advanced analysis functions may have restricted some aspects of data interpretation. Access to updated versions with more features could have enhanced the analytical capabilities. Strengths In-Depth Exploration: The qualitative phenomenological design allowed for an in-depth exploration of health professionals’ experiences, perceptions, and attitudes toward evidence-based practice (EBP). This approach facilitated a comprehensive understanding of both the facilitators and barriers to EBP adherence in the specific context of Tirunesh Beijing General Hospital. Diverse Data Collection Methods: Using both Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) enabled the study to capture a wide range of perspectives and insights. This diversity in data collection methods enriched the findings by incorporating individual experiences as well as group dynamics, which are crucial for understanding complex factors influencing EBP. Rigorous Data Analysis with ATLAS.ti: The use of ATLAS.ti software (version 9) for data analysis contributed to the systematic and organized handling of qualitative data. It facilitated the coding process and allowed for the in-depth analysis of themes, which enhanced the reliability of the findings. Triangulation to Ensure Validity: The study employed methodological triangulation by integrating KIIs and FGDs. This approach provided multiple sources of evidence, which strengthened the credibility and trustworthiness of the findings. Context-Specific Insights: Conducting the study at Tirunesh Beijing General Hospital provided valuable context-specific insights into EBP adherence among healthcare professionals in Addis Ababa. These findings are particularly relevant for similar hospitals under Addis Ababa city administration in Ethiopia, making the study valuable for informing hospital-specific interventions. Recommendation This study identified several key facilitators and barriers influencing adherence to evidence-based practice (EBP) among health professionals. To improve adherence and foster a more supportive EBP environment, the following recommendations are proposed: Institutionalize EBP Practices Health facilities should integrate EBP as a core standard within hospital policies. Creating structured EBP guidelines and protocols will provide a clear framework that guides health professionals in evidence-based decision-making. (Code: Establishment of Guidelines, Structured EBP Framework) Enhance Leadership Support and Advocacy Hospital leaders should actively promote EBP by showing commitment, allocating necessary resources, and encouraging staff to participate in evidence-based initiatives. Leadership support plays a crucial role in creating a culture where EBP is valued and applied consistently. (Code: Leadership Support, Support and Advocacy for EBP) Regular and Targeted Training Programs To enhance EBP knowledge and practical abilities, conduct thorough, continuous training sessions. Modules on critical appraisal, applying EBP in clinical settings, and adjusting to new findings should be part of this. Training programs should also be revised often to take into account the most recent findings in research and industry best practices. (Code: Comprehensive Training, Regular Training Updates, Provide Targeted Training) Integrate EBP into Electronic Medical Records (EMR) Incorporating EBP resources and guidelines within the hospital’s EMR system can help streamline access to evidence-based information during patient care. This integration encourages clinicians to use research-backed guidelines consistently, enhancing patient outcomes. (Code: Integration of EBP into EMR, System Compatibility) Reduce Workload and Address Resource Limitations Reducing excessive workloads through better staff-to-patient ratios or additional hires could significantly improve the capacity for EBP adherence. Addressing resource limitations, such as providing diagnostic equipment and other essential tools, will also facilitate more consistent EBP application. (Code: Reduction of Workload, Overcoming Resource Limitations) Encourage Continuous Learning and Collaboration Fostering a learning environment where health professionals are encouraged to continuously update their knowledge is essential. Hospitals can establish regular seminars, clinical audits, and workshops to review new evidence and assess current practices. Promoting collaboration and knowledge-sharing across departments can enhance the adoption of EBP principles. (Code: Foster Continuous Learning, Collaboration and Knowledge Sharing, Regular Clinical Audits) Shift from Traditional Practices to an EBP Model Encouragement should be given to the shift from dependence on expert opinion or conventional knowledge to an evidence-based approach. Change resistance can be reduced by highlighting the advantages of EBP, such as improved patient outcomes and more efficient use of resources. (Code: Shifting from Traditional to Evidence-Based Practice, Address Reliance on Expert Opinion, Attitude Shift) Implement Incentive Programs for EBP Engagement Motivation can be increased by creating rewards for medical personnel who actively use EBP. More adherence to EBP principles can be promoted by performance-based rewards, recognition initiatives, and career development opportunities. (Code: Incentives for Motivation, Encourage Active Participation) Focus on Compatibility with Hospital Systems Ensuring that hospital systems and infrastructure support EBP is crucial. Regular assessments of system compatibility, including EMR and other digital tools, can help identify technical barriers to EBP adherence. This will facilitate smoother integration of EBP practices within daily routines. (Code: Hospital System Compatibility) Suggestions for Future Research To build on the findings of this study, future research should investigate the long-term impact of structured EBP frameworks and incentives on EBP adherence. Studies could also explore specific barriers, such as resistance to change, in other healthcare settings to develop targeted interventions for similar contexts. Furthermore, quantitative research could help quantify the influence of facilitators like leadership support and collaboration on EBP adherence. Declarations Acknowledgments I would like to express my sincere gratitude to the healthcare professionals at Tirunesh Beijing General Hospital for their participation and valuable contributions to this study. I am also deeply thankful to my husband for his unwavering support throughout the research and manuscript preparation. Authors’ Contributions Abigiya Zewde Biru conceived and designed the study, conducted the interviews, performed the data analysis, and drafted the manuscript. Dr. Trhas Tadesse Berhe provided substantial contributions to the study design, critical review of the analysis, and manuscript revision. Both authors read and approved the final manuscript. Funding This research did not receive any specific funding from public, commercial, or non-profit organizations. Ethics Approval and Consent to Participate Ethical approval was sought from the Institutional Research Review Board (IRB) of Yekatit 12 Medical College with protocol number RPO/57/24. Additionally, ethical clearance was obtained from the Addis Ababa Public Health Research and Emergency Management Directorate. Permission to carry out the study was also granted by the administration of Tirunesh Beijing General Hospital. Participation in the study was voluntary, and after a detailed explanation of the study purpose, written informed consent was obtained from all participants. Confidentiality and privacy were maintained throughout the data collection process. All procedures were performed in accordance with the Declaration of Helsinki. Consent for Publication Not applicable. Competing Interests The author declares no competing interests. Availability of Data and Materials The datasets generated and/or analyzed during this study are available from the corresponding author upon reasonable request. References Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WSJB. Evidence based medicine: what it is and what it isn't. British Medical Journal Publishing Group; 1996. p. 71-2. Sackett DL, editor Evidence-based medicine. Seminars in perinatology; 1997: Elsevier. Sackett D. Evidence-based medicine: Seminars in perinatology. Elsevier Amsterdam; 1997. Sackett DL, Haynes RB, Tugwell P. 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Additional Declarations No competing interests reported. Supplementary Files Additionalfile1FocusGroupThemesandQuotes.docx Supplementaryfile2.KIIandFGDGuide.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 22 Jan, 2026 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Editor invited by journal 23 Jun, 2025 Submission checks completed at journal 21 Jun, 2025 First submitted to journal 21 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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the care of the individual patients\u0026rdquo;(1) ,which was later refined to \u0026ldquo;EBM is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values\u0026rdquo;(2)\u003c/p\u003e\n\u003cp\u003eEvidence-based medicine, or EBM, is a method of providing healthcare in which general practitionersbase their clinical judgments on the best available evidence, or the most pertinent data, for each patient. Clinical skills, understanding of disease mechanisms and pathophysiology are all valued, enhanced, and expanded upon by EBP. It entails making intricate and careful decisions based on patient preferences, circumstances, and traits in addition to the evidence that is currently accessible. It acknowledges that health care is personalized, dynamic, and subject to both probability and uncertainty. In the end, evidence-based practice (EBM) is the formalization of the care process that generations of the best health care professionals have used. More thorough explanations of EBP have been released(3, 4)\u003c/p\u003e\n\u003cp\u003eIn recent years, a number of definitions of EBP have been proposed. In order to reflect a common approach to evidence-based practice (EBP) across all health professions, the Sicily Statement(5) proposed expanding the original term \u0026quot;evidence-based medicine\u0026quot; to \u0026quot;evidence-based practice,\u0026quot; given that many health professionals have adopted an evidence-based way of practice.In addition to providing a precise definition of evidence-based practice (EBP), the Sicily Statement outlines the minimal educational and skill qualifications needed to practice EBP. This clarifies the fundamental procedures of EBP and creates a distinction between the process and the result of EBP(5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEBP has completely changed the way medicine is done during the last thirty years. Theoretically, its core principles\u0026mdash;management based on the Best Current Evidence, patient values and expectations, and physician skills and expertise\u0026mdash;remain unchanged. Its practical use in the age of information explosion has, however, undergone major changes. These changes include updated definitions, broader uses of the term EBM, and improved methods for recognizing the Best Current Evidence, advancements in research and clinical application, and EBM instruction(6).\u003c/p\u003e\n\u003cp\u003eEBP is becoming more and more common across a variety of medical specialties. Its dependence on the collaboration of objective scientific data, clinical judgment, and unique patient requirements and preferences is one of its key characteristics. Because it\u0026apos;s critical to locate and retrieve relevant literature from a variety of sources to aid in decision-making regarding medical care, librarians have a significant impact on the dissemination of evidence-based practice (EBP) (7) (Evidence is data/information from historical or scientific evaluations of procedures that can be utilized by healthcare industry decision-makers (8)\u003c/p\u003e\n\u003cp\u003eThe following five procedures comprise evidence-based practice: 1. Ask a question transforming the informational requirement into a question that can be answered, about things like therapy, diagnosis, prognosis, prevention, and causality. 2. Find information/evidence to answer question, searching for the most reliable information to address that query 3. Critically appraise the information/evidence, evaluating the evidence critically for its application (use in our clinical practice), impact (magnitude of the effect), and validity (closeness to the truth) 4. Integrate appraised evidence with own clinical expertise and patient\u0026rsquo;s preferences, combining the critical evaluation with our professional knowledge, our patients\u0026apos; particular biology, values, and circumstances, and 5. Evaluate, evaluating our effectiveness and efficiency in executing Steps 1-4 and seeking ways to improve them both for next time(9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEBP is the accepted and ideal standard for global trans-disciplinary healthcare providers, and it has the support of professional, national, and international healthcare organizations and regulatory bodies, including the National Academy of Medicine (NAM, 2022), the American Nurses Association (ANA, 2022), the Centers for Disease Control and Prevention (CDC, 2021), and the American Nurses Credentialing Center (ANCC, 2022). Reducing practice variability, improving patient outcomes, improving care quality, and lowering costs are the objectives of evidence-based decision-making (EBDM) (10).\u003c/p\u003e\n\u003ch2 id=\"_Toc184130380\"\u003e\u003cstrong\u003e1.2 Statement of the problems\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe amount of scientific knowledge that is now available to support medical professionals\u0026apos; clinical decision-making has increased dramatically in recent years. Despite the abundance of evidence, many healthcare systems in the US and around the world still do not implement evidence-based care because of cultural norms that keep people in their \u0026ldquo;comfort zones\u0026rdquo; and lack of competency in the EBP process among clinicians (11). Improving patient care outcomes within the framework of intricate healthcare systems is the aim of evidence-based practice, or EBP. However, the lack of daily consistency in the application of EBP by healthcare professionals makes it more difficult for healthcare organizations to provide high-quality, evidence-based care (12).\u003c/p\u003e\n\u003cp\u003eA study called Effectiveness of Evidence-Based Practice Education on Emergency Nurses\u0026rsquo; EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behaviour: A Randomized Controlled Trial, Six months after the course of study, the experimental group\u0026apos;s results seemed to be best from the evaluated EBP educational intervention. Nevertheless, the outcomes for the majority of EBP locations started to decline after six months. The results were at the baseline level, or in some cases, significantly lower, by the 12-month measurement point (13).\u003c/p\u003e\n\u003cp\u003eKnowledge, Attitude, and Practice towards Evidence-Based Medicine among Northern Saudi Primary Care Physicians: A Cross-Sectional Study Based on the PHC-based survey, we discovered that over half of the doctors had knowledge and attitudes about EBM that were either low or medium (14).\u003c/p\u003e\n\u003cp\u003eAnother study on Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice among Jordanian Nurses in Critical Care Units, EBP is influenced by a variety of factors, all of which fall under the responsibility of policy makers, administrators, physicians, researchers, and academics (15). Another study in Peru called Evidence-based practice among doctors in specialty training in a paediatric hospital, Nevertheless; paediatric specialists sometimes lack the time to look for scientific answers to the questions (16).\u003c/p\u003e\n\u003cp\u003eKnowledge, attitude and use of evidence-based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey showed that despite having a good attitude toward EBP, they were not fully implementing it because of a few obstacles, such as a lack of time. Despite their awareness of evidence-based practice (EBP), this study suggests that they still need to improve their ability to locate and evaluate evidence in order to effectively advocate for EBP to their management, colleagues, and junior nurses and midwives (17).\u003c/p\u003e\n\u003cp\u003eAccording to a study called The knowledge, attitudes, and practices of nurse educators regarding evidence-based practice at nursing education institutions in Lesotho, a significant portion of nurse educators at nursing education institutes in Lesotho lack EBP training, are unable to create targeted clinical questions to locate the required data, and do not use electronic databases (18).\u003c/p\u003e\n\u003cp\u003eHealth care professionals at public hospitals in the BunoBedele Zone and Illu Aba Bora generally practiced evidence-based medicine poorly (19). A study from North west Ethiopia showed that The majority of nurses did not fully utilize EBP (20) and another study from south Wollo zone \u0026nbsp; indicate, Nursing professionals have a low level of adoption of evidence-based practice (21).\u003c/p\u003e\n\u003cp\u003eA systematic review and meta-analysis Study called Determinants of evidence-based practice among health care professionals in Ethiopia showed that, it is necessary to increase the practice of utilizing the most recent research data in clinical decision-making for improved client care, as only around half (50%) of Ethiopian health professionals use evidence-based practice well (22).\u003c/p\u003e\n\u003cp\u003eTherefore, the Purpose of this study will be to explore adherence, barriers and facilitators of evidence-based practice and its associated factors among health care professionals in Tirunesh Beijing General Hospitals, Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130383\"\u003e\u003cstrong\u003e1.3 Social Cognitive Theory (SCT)\u003c/strong\u003e\u003c/h2\u003e"},{"header":"Significance of the study","content":"\u003cp\u003eAdherence to EBP is crucial in low- and middle-income country, like Ethiopia and throughout Africa, where the burden of disease is rising and there is a great need for EBP in clinical settings. In order to address the gaps in EBP adherence and remove barriers to EBP implementation, health institutions might make use of the information provided by this study. The study broadens the corpus of scientific information regarding the application of evidence-based health professional practice.\u003c/p\u003e \u003cp\u003e Given its critical role in patient care, the study on the adherence of evidence-based practice (EBP) and associated factors by health professionals working in Tirunesh Beijing General Hospital is important to design a strategic way to improve patient care outcomes by enhancing the application of new best evidence from research findings to the health professionals in the health sector. Government and non-government organizations involved in this field can also use the findings to inform the development of action plans and measures. Furthermore, national policies that incorporate EBP can be developed using the study's findings and will guide health professionals' education by identifying the areas of focus to include in the curriculum and also will serve as a baseline for other researchers conducting additional research using other research designs. In particular, it enhances patient outcomes and lowers health care costs\u0026mdash;a goal valued highly by funding and governmental organizations.\u003c/p\u003e"},{"header":"Objectives","content":"\u003ch2 id=\"_Toc184130386\"\u003e\u003cstrong\u003e3.1 General objective\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTo explore the facilitators and barriers influencing adherence to evidence-based practice among health professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130387\"\u003e\u003cstrong\u003e3.2 Specific objectives\u003c/strong\u003e\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eTo examine the current practice with regard to Adherence of evidence-based practice among health professionals working at Tirunesh Beijing General hospitals Addis Ababa, Ethiopia, 2024\u003c/li\u003e\n \u003cli\u003eTo explore barriers tothe adherence of evidence-based practice among health professionals working at Tirunesh Beijing General hospitals Addis Ababa, Ethiopia, 2024\u003c/li\u003e\n \u003cli\u003eTo explore facilitators to the adherence of evidence base practice among health professionals working at Tirunesh Beijing General Hospital Addis Ababa, Ethiopia 2024\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Methods","content":"\u003ch2 id=\"_Toc184130389\"\u003e\u003cstrong\u003e4.1 Study area and period.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was conducted at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia, from April 22 to August 20, 2024. Tirunesh Beijing General Hospital, located in Addis Ababa, served as the primary focus of this research. The hospital employs a total of 723 healthcare professionals and plays a pivotal role in providing comprehensive healthcare services to the community. The diverse range of healthcare professionals includes 32 with a Master of Public Health (MPH), 64 midwives, 321 nurses, 57 doctors, 55 pharmacy professionals, 50 specialists, and 134 other health professionals. Additionally, the hospital includes 58 case team leaders from various health disciplines and is organized into 15 directorates.\u003c/p\u003e\n\u003cp\u003eThe hospital is equipped with modern facilities and technology, catering to both inpatient and outpatient services. With high patient volumes and extended hospital stays, Tirunesh Beijing General Hospital faces significant challenges typical of healthcare facilities in Ethiopia. These challenges include addressing the rising burden of disease, managing drug resistance, and ensuring the delivery of evidence-based healthcare practices.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc184130390\"\u003e\u003cstrong\u003e4.2 Study design\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eA qualitative phenomenological design was employed to explore the lived experiences and perceptions of health professionals regarding evidence-based practice.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130391\"\u003e\u003cstrong\u003e4.3 Population\u003c/strong\u003e\u003c/h2\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc184130392\"\u003e\u003cstrong\u003e\u003cstrong\u003e4.3.1\u0026nbsp;\u003c/strong\u003eSource population\u003c/strong\u003e\u003c/span\u003e\u003c/h3\u003e\n\u003cp\u003eThe source population for this study was health professionals who worked at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. This included doctors, nurses, and other staff members involved in patient care or healthcare management within the hospital.\u003c/p\u003e\n\u003ch3 id=\"_Toc184130393\"\u003e\u003cstrong\u003e\u003cstrong\u003e4.3.2\u0026nbsp;\u003c/strong\u003eStudy population\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study participants consisted of a purposive sample of health professionals directly engaged in or possessing insights into evidence-based practice at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia. This sample encompassed individuals from diverse departments or specialties who had experience with implementation of evidence-based guidelines or protocols in their clinical practice. Participants included physicians, nurses, and pharmacists, who played active roles in healthcare delivery and decision-making processes related to evidence-based practice.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130394\"\u003e\u003cstrong\u003e4.4 Eligibility Criteria\u003c/strong\u003e\u003c/h2\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc184130395\"\u003e\u003cstrong\u003e\u003cstrong\u003e4.4.1\u0026nbsp;\u003c/strong\u003eInclusion criteria\u003c/strong\u003e\u003c/span\u003e\u003c/h3\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eHealth professionals directly employed by Tirunesh Beijing General Hospital.\u003c/li\u003e\n \u003cli\u003eIndividuals actively involved in patient care or healthcare management within the hospital.\u003c/li\u003e\n \u003cli\u003eParticipants with experience or involvement in evidence-based practice initiatives.\u003c/li\u003e\n \u003cli\u003eHealth professionals willing and able to participate in interviews or focus group discussions.\u003c/li\u003e\n \u003cli\u003eThose capable of providing informed consent and participating meaningfully, regardless of language proficiency or other potential barriers Who are working at Tirunesh Beijing General hospitals in Addis Ababa, Ethiopia, 2024.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e4.4.2\u0026nbsp;\u003c/strong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eHealth professionals not directly employed by Tirunesh Beijing General Hospital.\u003c/li\u003e\n \u003cli\u003eIndividuals who do not have any involvement in patient care or healthcare management.\u003c/li\u003e\n \u003cli\u003eParticipants who lack experience or involvement in evidence-based practice.\u003c/li\u003e\n \u003cli\u003eHealth professionals unwilling or unable to participate in interviews or focus group discussions.\u003c/li\u003e\n \u003cli\u003eThose who are unable to provide informed consent or participate due to language barriers or other reasons that may hinder meaningful participation.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003e\u003cstrong\u003e5.5 Sample size and Sampling technique /Sampling procedures\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eFor KIIs and Focus Group Discussions (FGDs) in this study, participants were selected from the source population based on their roles, experience, or involvement in evidence-based practice implementation or decision-making processes at the hospital. Key informants included department heads, quality improvement coordinators, quality officer and reform coordinators or individuals recognized for their expertise in evidence-based practice. Focus group discussions were conducted with groups of healthcare professionals from various departments to explore collective experiences, challenges, and facilitators related to the adherence to evidence-based practice. These participants provided valuable insights and perspectives through one-on-one interviews and group discussions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDetails of the data collection methods and the study population are summarized in Table 1.\u003c/p\u003e\n\u003cp id=\"_Toc183447252\"\u003eTable\u0026nbsp;1: Summary of Data Collection Methods and Study Population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMethod of data collection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eStudy population\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eKII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDepartment heads (Directorates)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eTeam leaders of various departments\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eQuality officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eOther individuals recognized for their expertise in evidence-based practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFGD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHealth professionals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eQuality improvement coordinators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eReform coordinator\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eResearch and\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130398\"\u003e\u003cstrong\u003e5.6 Sampling Procedures:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA total of 33 health professionals were selected from 723 health professionals at the hospital using purposive sampling. This method ensured the inclusion of individuals with specific expertise and roles relevant to the study\u0026apos;s focus.For the Key Informant Interviews (KIIs), 27 participants were chosen, including 5 department heads (Directorates), 4 team leaders from various departments, 3 quality officers, and 15 other individuals recognized for their expertise in evidence-based practice.\u003c/p\u003e\n\u003cp\u003eAdditionally, 6 health professionals were selected for the Focus Group Discussion (FGD), which included 2 health professionals, 2 quality improvement coordinators, 1 reform coordinator, and 1 research professional.This sampling approach ensured the inclusion of individuals who could provide rich, detailed, and relevant insights into the research topics related to evidence-based practice.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130399\"\u003e\u003cstrong\u003e5.7 Data Collection Procedures\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThese participants were selected through purposive sampling to ensure that those with relevant knowledge and experience were included. Interviews were semi-structured, allowing for in-depth exploration of specific topics while providing flexibility to probe further based on participants\u0026apos; responses. \u003cem\u003eThe semi-structured interview and focus group discussion guides used in this study were developed by the research team specifically for this study based on constructs of the Social Cognitive Theory. The English versions of both guides have been uploaded as supplementary material (see Supplementary file 2.KII and FGD Guide).\u003c/em\u003e Each interview was conducted in a private setting to ensure confidentiality and was audio-recorded with the participants\u0026apos; consent. The recordings were transcribed, converting the spoken words into written text exactly as they were said for subsequent analysis. The FGDs involved 6 health professionals selected to represent a diverse range of perspectives within the healthcare setting. Participants were purposively sampled to include nurses, doctors, and allied health staff. The discussions were facilitated by a trained moderator using a guide to ensure consistency across groups while allowing for dynamic interaction and the emergence of new themes. FGDs were held in a neutral and comfortable environment, audio-recorded with consent, and transcribed for detailed analysis. Throughout the data collection process, the study adhered to ethical standards, ensuring informed consent, confidentiality, and the right to withdraw at any time. Data was continuously reviewed and analyzed using thematic analysis to identify patterns and insights that emerged from the interviews and discussions. This iterative approach helped refine data collection and analysis, ensuring the study captured comprehensive and meaningful information.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130400\"\u003e\u003cstrong\u003e5.8 Data quality Assurance\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTo ensure the quality of the data, significant attention was given to the design and translation of the data collection instruments. The data was collected through Key Informant Interviews (KII) and a Focus Group Discussion (FGD), both conducted via audio recording. The interview guides were initially prepared in English, as the study participants were health professionals, and later translated into Amharic to ensure clarity, simplicity, and validity. Before the actual data collection, a pre-test was conducted with 7 health professionals (20% of the 33 respondents) at Zewditu Memorial Hospital. This pre-test helped identify any issues with the interview guides and ensured their appropriateness for the study population. Feedback from the pre-test was used to refine and improve the guides. Key Informant Interviews (KII) were conducted with selected health professionals who were considered knowledgeable about the study topic. These interviews provided in-depth, expert insights, ensuring that the data collected was rich and informative.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe KIIs were supplemented with the Focus Group Discussion (FGD), which enabled a more thorough examination of participants\u0026apos; viewpoints and experiences. In order to ensure that the sample was pertinent and representative of the target audience, participants for the KIIs and FGD were chosen based on their qualifications and experience. I personally collected the data, ensuring that both the KIIs and FGD were conducted in a consistent manner. I was careful to maintain confidentiality and ensure effective use of the audio recording equipment throughout the data collection process. The data was stored securely, and all recordings were transcribed and anonymized to maintain participant confidentiality. The reliability and validity of the interview guides were assessed after the pre-test with 7 health professionals. Any inconsistencies or issues identified during the pre-test were addressed, and necessary modifications were made to enhance the validity of the guides. Data saturation was monitored throughout the process, and data collection continued until no new information was emerging from the interviews or discussions.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130401\"\u003e\u003cstrong\u003e5.9 Operational Definitions:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eEvidence-Based Practice (EBP)\u003c/strong\u003e: Evidence-based practice is an approach to decision-making in which healthcare professionals integrate the best available research evidence, clinical expertise, and patient values and preferences to guide clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers to EBP:\u003c/strong\u003e Barriers to evidence-based practice refer to factors or obstacles that hinder the implementation or adoption of evidence-based approaches in clinical practice. These barriers can include organizational factors (e.g., lack of resources, time constraints), individual factors (e.g., lack of knowledge or skills in accessing and appraising research evidence), and contextual factors (e.g., resistance to change, organizational culture).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators of EBP\u003c/strong\u003e: Facilitators of evidence-based practice are factors or strategies that support and promote the implementation and adoption of evidence-based approaches in clinical practice. These facilitators can include organizational supports (e.g., access to resources, leadership support), educational interventions (e.g., training programs, continuing education), and professional networks (e.g., collaboration with colleagues, access to mentorship).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdherence to EBP\u003c/strong\u003e: Adherence to evidence-based practice refers to the degree to which healthcare professionals follow or adhere to evidence-based guidelines, protocols, or recommendations in their clinical practice. It involves consistently applying research evidence and best practices to inform clinical decision-making, treatment planning, and patient care.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130402\"\u003e\u003cstrong\u003e5.10 Trustworthiness of the Data\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIn ensuring the trustworthiness of the data collected, several key strategies were implemented. First, to enhance credibility, member checking was conducted, allowing participants to review and validate the accuracy of their contributions. Additionally, an audit trail was maintained to establish dependability, documenting all steps of the research process for transparency and replicability. Confirmability was ensured through peer debriefing, involving external reviewers to verify the objectivity and neutrality of interpretations. Finally, to address transferability, a detailed description of the research context, participants, and methods was provided, allowing readers to assess the relevance and applicability of the findings to other similar settings or populations. These measures collectively upheld the integrity and reliability of the study\u0026apos;s findings, fostering confidence in the insights gathered regarding evidence-based practice adherence within the healthcare context of Tirunesh Beijing Hospital.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130403\"\u003e\u003cstrong\u003e5.11 Data Analysis Procedures\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe data were systematically analysed following established procedures. First, the audio recordings of interviews or focus group discussions were transcribed word for word, without any alterations or omissions, to ensure accuracy and completeness. The transcribed data were then organized and labelled systematically for easy reference during analysis. The data were familiarized by reading and re-reading the transcripts, making notes of initial impressions and recurring themes. ATLAS.ti version 9.1.3.0 was employed to identify and label meaningful segments of text, which were then grouped into broader categories or themes. Constant comparison was used to refine and elaborate on existing themes, while memos were written to capture reflections and insights throughout the analysis process. Peer debriefing and member checking were conducted to validate interpretations and ensure accuracy. Data saturation was assessed to determine if enough data had been collected to fully explore the research questions. Finally, the findings were synthesized and integrated into coherent narratives or theoretical frameworks, which were reported using rich, descriptive language in accordance with qualitative research reporting guidelines.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130404\"\u003e\u003cstrong\u003e5.12 Ethical Consideration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc184130405\"\u003eThe Institutional Review Board (IRB) of Yekatit 12 Medical College, College of Public Health, and Department of Quality Health Care reviewed the protocol to ensure full protection of the rights of study subjects. Following approval by the IRB, an official letter of cooperation was sent to the Addis Ababa Regional Health Bureau from the Department of Quality Health Care of Yekatit 12 Medical College. After receiving permission from the Addis Ababa Regional Health Bureau, a letter of cooperation was sent to Tirunesh Beijing General Hospital. As the data collector, I was informed about the study after receiving approval from the hospital. Verbal and written informed consent were obtained from study subjects. Confidentiality was assured for all the information provided, and no personal identifiers (anonymity) were used on the questionnaires.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e5.13 Dissemination of Results\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eResults will be disseminated to Tirunesh Beijing General Hospital and Yekatit 12 Medical College, Department of Quality Health Care through documentation. To researchers and students, the results will be disseminated through presentations. If possible, it will be accessible on internet for all through publication.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cstrong\u003eSocio-Demographic Characteristics of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 33 participants were included in this study, comprising 27 from Key Informant Interviews (KIIs) and 6 from a Focus Group Discussion (FGD). \u0026nbsp;\u003cem\u003eThe demographic data below represent all participants. Thematic results from the FGD are presented separately in \u003cem\u003eSupplementary File 1\u003c/em\u003e for clarity and space considerations\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of participants were male (78.8%), while females made up 21.2%. Most participants (75.7%) were aged between 31 and 40 years, with smaller proportions aged 20-30 years (18.1%) and 41-50 years (6%).Regarding educational status, a significant proportion (66.6%) of participants held a Master\u0026rsquo;s degree or higher, reflecting a highly educated cohort, while 33.3% held a Bachelor\u0026apos;s degree. In terms of professional experience, 48.4% had 5-10 years of work experience, and 42.4% had more than 10 years, showcasing a wealth of expertise within the sample.Professionally, nurses and midwife with a Master\u0026rsquo;s in Public Health (MPH) were the largest group (27.2%), followed by specialists (24.2%), general practitioners (18.2%), and Pharmacists with advanced degrees (15.1%). Health officers, Laboratory technologists, Anaesthetists, and midwives were less represented, with each group accounting for 3-6% of the total sample. Participants held diverse roles, with 24.2% serving as team leaders and 15.1% in directorate positions, while the majority (60.6%) were classified under other roles, reflecting a broad range of professional responsibilities.\u003c/p\u003e\n\u003cp\u003eThe following table provides a detailed breakdown of the socio-demographic characteristics of all participants and is presented below as Table 2:\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc183447253\"\u003eTable 2: Socio-demographic characteristics of Key Informant Interview (KII) and Focus Group Discussion (FGD) participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eKII (n = 27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eFGD (n = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eTotal (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e21 (77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e26 (78.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7(21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eProfession\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eSpecialists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eGeneral Practitioners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e6 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eMPH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e9 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eHealth Officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003ePharmacists (Master\u0026apos;s in Pharmacy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eLaboratory Technologists (Master\u0026apos;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eAnaesthetist Master\u0026apos;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eMidwife\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRole\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e5 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eTeam Leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e5 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e17 (62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e20 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEducational status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e10 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e11 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eMaster\u0026apos;s and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e17 (62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e22 (66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e19 (70.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e25 (75.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYear of experience\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eLess than 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003e5-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e15 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e16 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eMore than 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc181043666\"\u003eNotes:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eKII Participants (Key Informant Interviews): 26 individuals from various professions.\u003c/li\u003e\n \u003cli\u003eFGD Participants (Focus Group Discussion): 6 individuals from different backgrounds\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc184130407\"\u003e6.1. Results of Key Informant Interviews (KIIs)\u003c/span\u003e\u003c/h2\u003e\n\u003ch2 id=\"_Toc184130408\"\u003eTheme 1: Understanding of Evidence-Based Practice (EBP)\u003c/h2\u003e\n\u003cp\u003eThe majority of participants demonstrated a strong understanding of Evidence-Based Practice (EBP), highlighting its importance in improving patient outcomes, standardizing clinical practices, and integrating research evidence with clinical expertise. The key themes that emerged include the integration of research evidence into clinical decision-making, the adherence to established guidelines and protocols, and the consistent application of EBP across healthcare settings to enhance the quality of care \u003cstrong\u003e(see Figure 2).\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130409\"\u003e\u003cstrong\u003eSub-theme 1.1: Definitions and personal interpretations of EBP\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMost respondents defined EBP as a \u003cstrong\u003estructured approach\u003c/strong\u003e to healthcare, integrating clinical expertise with the \u003cstrong\u003ebest available research\u003c/strong\u003e to ensure practices are evidence-based and aligned with \u003cstrong\u003estandardized protocols\u003c/strong\u003e. This understanding underlines the goal of delivering high-quality, efficient treatment while adhering to \u003cstrong\u003eestablished guidelines\u003c/strong\u003e. As one respondent noted:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Evidence-based practice combines the best available research findings, such as opinion-based studies, cohort studies, and randomized controlled trials, with clinical experience.When guidelines are established based on these studies, they provide a framework for clinical decision-making.\u0026rdquo; (Respondent 15,\u003cstrong\u003e44:1 \u0026para; 32\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eSome participants emphasized that EBP bridges traditional practices and modern advancements by incorporating evolving knowledge into daily practice. For instance, many highlighted the transition from relying solely on physical examinations to utilizing advanced diagnostic tools, such as CT scans, as a significant improvement. One respondent shared:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In the past, we made all of our diagnosis and treatment decisions based only on physical examinations.Thanks to evidence-based practice (EBP), we can now use sophisticated instruments like CT scans, which facilitate quicker and easier diagnosis processes and enable us to act more rapidly.\u0026rdquo; (Respondent 2, \u003cstrong\u003e31:7 \u0026para; 41\u003c/strong\u003e).\u003c/p\u003e\n\u003cp id=\"_Toc181043670\"\u003eAdditionally, respondents stressed that EBP involves making treatment decisions supported by accurate, thoroughly researched, and reliable data. This ensures that clinical decisions are well-informed and tailored to improve patient outcomes. One participant elaborated:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;When making treatment decisions for patients, medical professionals can use Evidence-Based Practice (EBP), which is the process of compiling evidence supported by many research.\u0026rdquo; (Respondent 1, 30:16 \u0026para; 32).\u003c/p\u003e\n\u003cp\u003eAnother respondent summarized the essence of EBP by highlighting its integration of research findings and clinical expertise:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;It allows us to combine clinical expertise with the most recent research findings to make well-informed decisions.\u0026rdquo; (Respondent 2,31:1 \u0026para; 32).\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc184130410\"\u003e\u003cstrong\u003eSub-theme 1.2: General knowledge and awareness of EBP principles\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThe responses reflected a strong awareness of Evidence-Based Practice (EBP) principles, with participants emphasizing the importance of basing clinical decisions on solid evidence rather than arbitrary judgments. Respondents highlighted the integration of technology with clinical data and patient history as essential for ensuring precision and alignment with best practices. For instance, one participant stated:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Through the integration of these technologies with clinical data and patient history, we guarantee that our actions are precise and in line with established best practices\u0026rdquo; (Respondent 2, \u003cstrong\u003e31:2 \u0026para; 32\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe responses also highlighted that respondents are aware of the need to adapt \u003cstrong\u003eEBP principles\u003c/strong\u003e to \u003cstrong\u003enew challenges\u003c/strong\u003e, including integrating \u003cstrong\u003enew technologies\u003c/strong\u003e and \u003cstrong\u003eguidelines\u003c/strong\u003e into practice. Respondents acknowledged the importance of using \u003cstrong\u003eevolving evidence\u003c/strong\u003e and \u003cstrong\u003eup-to-date research\u003c/strong\u003e to enhance clinical decisions. For instance:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;EBP assists us in adjusting to changing situations, workforce availability, and resource availability.\u0026rdquo; (Respondent 12, \u003cstrong\u003e50:41 \u0026para; 32\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eRespondents commonly recognized the necessity of adhering to high standards and rigorous quality controls when applying EBP. These principles were described as essential for ensuring that treatments align with best practices, as well as for ensuring that the evidence supporting them has been thoroughly analyzed. Many respondents also noted that maintaining up-to-date information is crucial for effective application. For example: Respondent 12 mentioned:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;By referencing established quality standards, we align our practices with evidence-based guidelines, ensuring effective and reliable patient care\u0026rdquo; (Respondent 12,49:34 \u0026para; 32).\u003c/p\u003e\n\u003cp\u003eThere was a consensus among respondents regarding the importance of having a broad understanding of EBP principles. Most recognized that EBP is not static but requires \u003cstrong\u003eadapting to changing circumstances\u003c/strong\u003e such as shifts in guidelines, available resources, or evolving health conditions. One respondent mentioned how healthcare professionals must remain flexible in applying EBP:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;EBP assists us in adapting to changing circumstances, such as fluctuating labor availability, resources, and circumstances.\u0026rdquo; (Respondent 13,\u003cstrong\u003e\u0026nbsp;41 \u0026para; 32\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003eAdditionally, respondents pointed out the need for \u003cstrong\u003eadhering to both international and local guidelines\u003c/strong\u003e in clinical decision-making. However, they acknowledged the challenges of potential inconsistencies when different practitioners follow different guidelines. One respondent expressed concern over this issue:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If some practitioners adhere to U.S. guidelines while others follow national or regional guidelines, inconsistencies may arise in treatment protocols.\u0026rdquo; (Respondent 7,\u003cstrong\u003e\u0026nbsp;36:44 \u0026para; 55\u003c/strong\u003e)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130411\"\u003e\u003cstrong\u003eSub-theme 1.3: Perceived importance of EBP in clinical practice\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents strongly agreed on the perceived \u003cstrong\u003eimportance of Evidence-Based Practice (EBP)\u003c/strong\u003e in clinical practice. The majority emphasized that \u003cstrong\u003eEBP\u003c/strong\u003e is not only integral to improving \u003cstrong\u003etreatment outcomes\u003c/strong\u003e but also crucial for \u003cstrong\u003eenhancing patient care\u003c/strong\u003e and \u003cstrong\u003eensuring optimal healthcare delivery\u003c/strong\u003e. Respondent 7 noted that EBP\u0026rsquo;s integration of \u003cstrong\u003ehigh-quality research\u003c/strong\u003e into clinical practice is fundamental in improving care:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;EBP enhances the quality of care and ensures continuous improvement in healthcare delivery\u0026rdquo; (Respondent 7, 36:27 \u0026para; 44).\u003c/p\u003e\n\u003cp\u003eThe perceived value of EBP was also expressed in terms of its role in \u003cstrong\u003eadapting to evolving healthcare challenges\u003c/strong\u003e. Respondents pointed out that staying current with evidence not only ensures \u003cstrong\u003ebetter decision-making\u003c/strong\u003e but also facilitates the \u003cstrong\u003eapplication of new knowledge\u003c/strong\u003e to address contemporary health issues. Respondent 12 elaborated on the role of EBP in \u003cstrong\u003eadapting to medical advancements\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Adapting to the latest evidence and procedures because medical practice is continuously advancing\u0026rdquo; (Respondent 12, 50:17 \u0026para; 46).\u003c/p\u003e\n\u003cp\u003eMoreover, the majority of the respondents linked \u003cstrong\u003eEBP to the continuous improvement of healthcare interventions\u003c/strong\u003e, noting that by relying on \u003cstrong\u003eup-to-date evidence\u003c/strong\u003e, clinicians can ensure that their \u003cstrong\u003epractices remain effective\u003c/strong\u003e and \u003cstrong\u003eefficient\u003c/strong\u003e. Respondent 6 highlighted the importance of applying \u003cstrong\u003ereliable evidence\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In this globalized age, when people have access to a wealth of knowledge, I think it\u0026apos;s essential to comprehend and use it wisely.\u0026rdquo; (Respondent 6,35:12 \u0026para; 43).\u003c/p\u003e\n\u003cp\u003eThe majority of respondents emphasized the essential role of Evidence-Based Practice (EBP) in healthcare delivery. Most of them highlighted that EBP is critical to clinical practice because it ensures that services and treatments are based on the best available evidence, which ultimately enhances the quality of care and patient outcomes. Respondents noted that continuous learning and the acquisition of practical skills are fundamental to successfully integrating EBP into clinical settings. A key point made was that having access to up-to-date information and staying informed through regular training opportunities were crucial for maintaining adherence to EBP \u003cstrong\u003e(see Figure 3).\u003c/strong\u003e For example, Respondent 6 stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Access to up-to-date information, continuous learning, and skill development are important factors that facilitate adherence to evidence-based practice at Tirunesh Beijing General Hospital.\u0026rdquo; (Respondent 6:)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130412\"\u003eTheme 2: Strategies and Initiatives that Promote EBP\u003c/h2\u003e\n\u003cp\u003eIn exploring successful strategies for promoting evidence-based practice (EBP), a common theme that emerged from the majority of participants focused on the establishment of clear protocols and guidelines, the integration of advanced technologies, and the creation of a culture that supports ongoing improvement and education. Below, we break down the findings under the following three sub-themes, highlighting the key points made by the respondents.\u003c/p\u003e\n\u003ch2 id=\"_Toc181043673\"\u003e\u003cstrong\u003eSub-theme 2.1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEstablishing Clear Protocols and Guidelines to Promote EBP\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA prominent strategy discussed by respondents is the development and adherence to clear protocols and guidelines that standardize healthcare practices and ensure consistency in the delivery of care. Most respondents highlighted that structured and regularly updated guidelines contribute significantly to successful EBP adherence. For instance, Respondent 1 shared:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We have outlined the appropriate treatment for patients with specific conditions in our clearly defined scope of practice for physicians. This entails creating detailed protocols for every disease entity and making sure they are implemented in clinical settings.\u0026rdquo; (Respondent 1, 30:18 \u0026para; 36)\u003c/p\u003e\n\u003cp\u003eThis practice is particularly emphasized in departments like nursing, where creating and executing guidelines that promote evidence-based care is a focal point. Respondent 7 added:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Administratively, promoting EBP can be supported by clear guidelines and protocols that encourage adherence.\u0026rdquo; (Respondent 7, 36:12 \u0026para; 35)\u003c/p\u003e\n\u003ch2 id=\"_Toc181043674\"\u003e\u003cstrong\u003eSub-theme 2.2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIntegration of Advanced Technologies and Tools to Support EBP\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAnother vital strategy identified by the respondents is the integration of advanced technologies to facilitate and support EBP. This includes using evidence-based technologies to ensure the collection of accurate data and the application of best practices. Respondent 1 explained the use of technological integration:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;These standards are developed through extensive trials, expert opinions, and the integration of these technologies with clinical data to enhance patient care.\u0026rdquo; (Respondent 3, 32:3 \u0026para; 32)\u003c/p\u003e\n\u003cp\u003eSome respondents pointed to the integration of advanced diagnostic technologies and tools as a major factor in supporting EBP. They stressed that the use of cutting-edge tools such as CT scans, online databases, and diagnostic platforms enhances clinical decisions and patient outcomes. This combination of technology with clinical expertise forms the backbone of modern EBP approaches.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Integrating advanced diagnostic technologies like CT scans with clinical knowledge is one effective neurosurgical approach that supports evidence-based practice\u0026rdquo; (Respondent 2, 31:4 \u0026para; 36).\u003c/p\u003e\n\u003cp\u003eAdditionally, the implementation of international standards like ISO 15189 was recognized as crucial for maintaining high-quality practices, with Respondent 9 stating:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Implementing ISO 15189 standards have proven effective in ensuring quality results.\u0026rdquo; (Respondent 9: 49:37 \u0026para; 35)\u003c/p\u003e\n\u003cp\u003eLastly, EMR (Electronic Medical Recording) systems represent a key technological tool that supports EBP by making patient data more accessible, accurate, and consistent across different departments. The integration of EHRs enables healthcare providers to align their practices with the latest evidence and clinical guidelines by providing real-time access to patient histories, lab results, and treatment plans. This helps Equipping Staff to Maintain Standards\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Ensuring that our team is well-informed and equipped to maintain these high standards is essential, especially when integrating new technologies such as EHRs.\u0026rdquo; (Respondent 9, \u0026para; 35)\u003c/p\u003e\n\u003ch2 id=\"_Toc181043675\"\u003e\u003cstrong\u003eSub-theme 2.3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCultivating a Culture of Continuous Improvement and Education\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents stressed the importance of creating a culture of continuous education and improvement as an essential factor for fostering EBP. Regular seminars, research discussions, and workshops help update healthcare professionals on the latest evidence, ensuring that practices remain current. Respondent 12 shared:\u003c/p\u003e\n\u003cp\u003eRegular morning and seminar sessions, experience sharing, and discussions around evidence-based best practices help align our approach with the latest research.\u0026rdquo; (Respondent 12: 50:24 \u0026para; 49)\u003c/p\u003e\n\u003cp\u003eThe necessity of ongoing education and professional development to advance EBP was a recurrent subject among those surveyed. It was stated that creating a culture that promotes lifelong learning, skill improvement, and involvement in research is crucial. According to the respondents, cultivating such a culture improves healthcare professionals\u0026apos; capacity to apply EBP successfully and keeps them up to date on the most recent research.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Fostering a culture of continuous improvement in healthcare\u0026rdquo; (Respondent 9: 49:21 \u0026para; 45).\u003c/p\u003e\n\u003ch2 id=\"_Toc184130416\"\u003eTheme 3: Challenging Situations in adherence to EBP\u003c/h2\u003e\n\u003cp\u003eThe majority of respondents identified various challenges in adherence to Evidence-Based Practice (EBP), focusing primarily on issues related to access to resources, resistance to change among staff, and workload challenges. These barriers significantly impact the adoption of EBP, leading to inconsistencies in patient care and hindering the effectiveness of clinical decision-making.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130417\"\u003e\u003cstrong\u003eSub-theme 3.1:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Access\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;to evidence or resources\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eLimited access to evidence or resources is a significant barrier to the effective implementation of EBP. Many healthcare professionals expressed difficulties in obtaining current and relevant research due to insufficient resources. Respondents emphasized the need for advanced tools and resources to support EBP, while also acknowledging the limitations in their availability.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The absence of sufficient diagnostic resources presents a major obstacle in implementing evidence-based practices\u0026rdquo; (Respondent 1:30:20 \u0026para; 40).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The availability of modern diagnostic equipment, especially MRI machines, is limited, affecting our ability to apply EBP efficiently\u0026rdquo; (Respondent 2: 31:18 \u0026para; 56).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There\u0026rsquo;s just not enough access to the latest studies; we often rely on outdated information because we can\u0026rsquo;t find the evidence we need.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Improving the hospital\u0026rsquo;s system setup is crucial to support evidence-based practice effectively.\u0026rdquo; (Respondent:32:30 \u0026para; 68)\u003c/p\u003e\n\u003cp\u003eSeveral respondents highlighted that limited access to resources and outdated diagnostic tools make it challenging to adhere to evidence-based practices (EBP). Issues such as equipment shortages, power outages, and insufficient staffing were recurrent themes.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The availability of resources is a key barrier to adhering to evidence-based practice, especially given budgetary constraints and economic issues.\u0026rdquo; (Respondent 2: 31:23 \u0026para; 64)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Frequent power outages disrupt EMR, limiting our ability to use EBP fully.\u0026rdquo; (Respondent 7: 35:20 \u0026para; 54)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Improving the hospital\u0026rsquo;s system setup is crucial to support evidence-based practice effectively.\u0026rdquo; (Respondent 3: 32:30 \u0026para; 68)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130418\"\u003e\u003cstrong\u003eSub-theme 3.2: Resistance to change among staff\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eStaff resistance to change was a recurrent theme. This resistance often results from a lack of knowledge about EBP principles, inadequate training, or a reluctance to embrace new practices that might interfere with long-standing habits.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I\u0026rsquo;ve been doing things this way for years; why change what seems to work?\u0026rdquo; (Respondent 5:\u0026nbsp;36:33 \u0026para; 50)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Without a unified policy or protocol from national policymakers, the variation in protocols between hospitals creates resistance among staff\u0026rdquo; (Respondent 15: \u0026para;57).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Resource limitations, including insufficient training for staff, are a significant obstacle to consistent EBP implementation\u0026rdquo; (Respondent 14: \u0026nbsp;\u0026para;52).\u003c/p\u003e\n\u003cp\u003eResistance to adopting new practices was another key barrier. Many respondents noted that healthcare professionals often rely on previous experiences, creating reluctance to incorporate newer, evidence-based approaches.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Challenges arise when senior professionals rely solely on expert opinion, disregarding newer, evidence-based updates.\u0026rdquo; (Respondent 7, 36:18 \u0026para; 39)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We worked without clear direction\u0026mdash;essentially, acting \u0026lsquo;without a clue,\u0026rsquo; as staff were hesitant to embrace structured EBP methods.\u0026rdquo; (Respondent 9, 49:16 \u0026para; 38)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Resistance to change is often rooted in attitudes, which can hinder integration of new practices.\u0026rdquo; (Respondent 14, 36:40 \u0026para; 52)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130419\"\u003e\u003cstrong\u003eSub-theme 3.3: Time constraints and workload challenges\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTime constraints and workload challenges significantly impede the integration of EBP. Healthcare professionals often cite heavy patient loads and competing responsibilities as barriers to engaging with EBP initiatives, leading to inconsistent application.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Applying Evidence-Based Practice (EBP) can be challenging due to variations in how it is implemented and the time needed for thorough application\u0026rdquo; (Respondent 3, \u0026para;41).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There are instances where certain practices may not be feasible due to time constraints and the pressure of daily workloads\u0026rdquo; (Respondent 13, \u0026para;49).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;This neglect can lead to serious consequences for patient care, undermining the goals of EBP\u0026rdquo; (Respondent 9, \u0026para;54).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I barely have time to see my patients, let alone look up new evidence or attend training sessions.\u0026rdquo;(Respondent 7)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130420\"\u003e\u003cstrong\u003eSub-theme 3.4: Data Management and Decision-Making Challenges\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eProper data management was identified as a cornerstone of EBP, yet respondents cited difficulties with data collection, tracking, and decision-making. Inadequate monitoring of treatment outcomes, such as death rates in emergency rooms, led to less-informed decision-making.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;One of the significant challenges in implementing EBP is improper data collection, which undermines the reliability of treatment decisions.\u0026rdquo; (Respondent 10, 51:17 \u0026para; 39)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We faced issues tracking sudden death rates due to inadequate data collection, affecting our ability to create effective indicators.\u0026rdquo; (Respondent 10: 51:35 \u0026para; 39)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Data-driven frameworks are essential for decision-making processes, yet they are often not fully established in practice.\u0026rdquo; (Respondent 15: 51:6 \u0026para; 32)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130421\"\u003e\u003cstrong\u003eSub-theme 3.5: Quality and Outcomes Challenges\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSeveral respondents expressed concerns over the quality of evidence used in clinical settings. Distinguishing between high- and low-quality studies was mentioned as a challenge that could directly impact patient care outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The inability to differentiate between high- and low-quality studies creates further challenges, risking the application of poor-quality research.\u0026rdquo; (Respondent 7: 36:21 \u0026para; 39)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In settings where resource limitations are prevalent, implementing EBP can be difficult and may not yield the desired outcomes.\u0026rdquo; (Respondent 14: 43:8 \u0026para; 41)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130422\"\u003eTheme 4: Success Stories in adherence to EBP\u003c/h2\u003e\n\u003cp\u003eEvidence-Based Practice (EBP) is recognized by respondents as a transformative approach that significantly improves patient outcomes and healthcare delivery. Respondents emphasized that EBP enhances clinical practices, reduces mortality rates, improves decision-making, and ensures consistent, error-free care.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130423\"\u003e\u003cstrong\u003eSub-theme 4.1: Positive outcomes from EBP adherence (improved patient care, efficiency)\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents highlighted that EBP has significantly improved patient care and efficiency in healthcare delivery. Effective adherence to EBP was reported to lead to better patient outcomes, streamlined processes, and overall enhanced quality of care. Respondents shared how EBP supports precise diagnoses, consistency in treatment, and resource efficiency:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Despite these challenges, EBP has been successful in transforming patient care and improving quality. When effectively adhered, EBP leads to better patient outcomes and enhanced healthcare delivery, demonstrating its value in advancing clinical practice.\u0026rdquo;(Respondent 3: 32:10 \u0026para;42)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We have seen significant benefits from integrating EBP into our processes, leading to better patient care and enhanced decision-making.\u0026rdquo;(Respondent 9: \u0026nbsp;49:36 \u0026para; 40)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;It is an essential part of providing efficient, quality healthcare.\u0026rdquo;(Respondent 1: 30:27 \u0026para; 46)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We guarantee more precise diagnoses and improved patient outcomes.\u0026rdquo;(Respondent 2: 31:13 \u0026para; 48)\u003c/p\u003e\n\u003cp\u003eRespondents also shared specific examples:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Since we adopted evidence-based protocols, our patient care has significantly improved, leading to a noticeable reduction in complications\u0026rdquo; (Respondent 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother respondent emphasized the efficiency gained, stating,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Implementing EBP has streamlined our processes and helped us use resources more effectively, which ultimately benefits our patients\u0026rdquo; (Respondent 3).\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130424\"\u003e\u003cstrong\u003eSub-theme 4.2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003einterdisciplinary collaboration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents noted that EBP fosters interdisciplinary teamwork, enabling healthcare professionals from various fields to collaborate effectively. This teamwork helps standardize care and integrate diverse perspectives, ultimately improving healthcare delivery.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Experience sharing and ongoing training play significant roles in implementing EBP across departments.\u0026rdquo; (Respondent 9)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Handled complex cases through experience sharing, showing that interdisciplinary support is essential for successful application.\u0026rdquo; \u0026nbsp;(Respondent 12)\u003c/p\u003e\n\u003cp\u003eKey Quote: \u0026ldquo;On the successful side, we\u0026rsquo;ve managed to handle complex cases through collaboration and discussion around evidence-based best practices\u0026rdquo; (Respondent 12),\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA positive attitude towards EBP was also seen as crucial for fostering interdisciplinary collaboration.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Therefore, fostering a positive attitude towards EBP is essential for enhancing interdisciplinary collaboration.\u0026rdquo;(Respondent 9: 49:1 \u0026para; 54)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;An open and adaptive attitude towards EBP is crucial for effectively integrating interdisciplinary collaboration.\u0026rdquo;(Respondent 3: 32:25 \u0026para; 63)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Ultimately, evidence-based practice is a matter of life and death, guiding healthcare professionals in their interdisciplinary roles to provide better care.\u0026rdquo;(Respondent 13: 42:14 \u0026para;43)\u003c/p\u003e\n\u003cp\u003eSpecific examples highlighted the benefits of collaboration:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Working together as a team\u0026mdash;doctors, nurses, and pharmacists\u0026mdash;has allowed us to integrate various perspectives and improve our care plans\u0026rdquo; (Respondent 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Our interdisciplinary meetings have fostered better communication and teamwork, which have been crucial for applying the best available evidence in patient care\u0026rdquo; (Respondent 4).\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130425\"\u003e\u003cstrong\u003eSub-theme 4.3: \u0026nbsp;Decision-making through EBP\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents agreed that EBP enhances healthcare decision-making by providing thoroughly researched, evidence-based guidelines. This approach minimizes reliance on outdated methods or intuition, resulting in more precise and efficient clinical decisions.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;EBP allows us to improve the quality of our services, leading to better patient care and enhanced decision-making.\u0026rdquo; Respondent 9 (49:13 \u0026para; 40)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Regularly conducting clinical audits to evaluate adherence to evidence-based practice ensures better decision-making and patient outcomes.\u0026rdquo; Respondent 14 (43:5 \u0026para; 37)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We guarantee more precise diagnoses and improved patient outcomes, which result from better clinical decision-making based on EBP.\u0026rdquo; Respondent 2 (31:5 \u0026para; 36)\u003c/p\u003e\n\u003cp\u003eRespondents highlighted the reduction of variability and adherence to clinical guidelines as key benefits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;With EBP, we rely on high-quality research rather than just our experience, which has improved the effectiveness of our interventions\u0026rdquo; (Respondent 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The shift towards evidence-based decision-making has reduced variability in our practices and improved adherence to clinical guidelines\u0026rdquo; (Respondent 6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, EBP was recognized as critical for patient safety and quality improvement:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Guidelines create opportunities for effective treatment,\u0026rdquo; emphasizing that evidence-based decision-making directly impacts patient outcomes. (Respondent 13)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Ultimately, evidence-based practice is a matter of life and death, guiding us to make the best possible choices for patient care\u0026rdquo; (Respondent 13).\u003c/p\u003e\n\u003ch2 id=\"_Toc184130426\"\u003eTheme 5: Factors Facilitating Adherence to EBP\u003c/h2\u003e\n\u003cp\u003eAdherence to Evidence-Based Practice (EBP) is driven by factors such as resource availability, leadership support, and continuous training. These elements create an environment where healthcare professionals can consistently apply updated knowledge in their practice. Institutional backing, professional development opportunities, and individual motivation were highlighted as critical drivers for sustained adherence and meaningful improvements in clinical care.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130427\"\u003e\u003cstrong\u003eSub-theme 5.1: Availability of training and professional development\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eContinuous professional development (CPD) emerged as a crucial factor in maintaining adherence to EBP. Respondents frequently cited the importance of specialized training sessions, workshops, and bedside audits to reinforce EBP principles. CPD opportunities ensure healthcare staff stay informed about the latest EBP guidelines and practices, creating a foundation for effective implementation.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Providing continuous professional development (CPD) training for clinical staff, ensuring they stay updated with EBP principles.\u0026rdquo; (Respondent 3, \u0026para;37)\u003c/p\u003e\n\u003cp\u003eTraining opportunities such as clinical audits, morning sessions and rounds activities help ensure that healthcare staff stay informed about the latest EBP guidelines and practices.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Conducting clinical audits and reviewing patient charts help ensure that practices are aligned with EBP guidelines.\u0026rdquo; (Respondent 3, \u0026para; 51)\u003c/p\u003e\n\u003cp\u003eRegular updates, such as interdisciplinary rounds and the sharing of new guidelines, also play a significant role. Respondents noted that multidisciplinary approaches create enriched learning environments that foster collaboration and reinforce adherence to EBP.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We share and normalize updated guidelines that we\u0026rsquo;ve developed in clinical rounds, helping staff stay current with EBP standards.\u0026rdquo; (Respondent 12, \u0026para; 35)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Multidisciplinary approach strengthens adherence to evidence-based practices across departments.\u0026rdquo; (Respondent 12, \u0026para; 49)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130428\"\u003e\u003cstrong\u003eSub-theme 5.2: Institutional support (leadership, resources)\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eStrong institutional support was repeatedly identified as essential for EBP adherence. Leadership commitment, resource provision, and fostering a culture of accountability were highlighted as critical components. Respondents noted that effective leaders set positive examples, allocate necessary resources, and create an environment conducive to evidence-based practices.\u003c/p\u003e\n\u003cp\u003eFor instance, the Ministry of Health\u0026apos;s initiatives, such as SBFR and EHAQ, provide structured guidance and resources to sustain EBP. Hospital administrators also play a vital role by ensuring the availability of essential medical devices, even amidst resource shortages.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The Ministry of Health\u0026apos;s initiatives, like the SBFR, EHAQ, and EBC programs, offer great assistance and direction\u0026hellip; guaranteeing that EBP will continue to be developed and implemented.\u0026rdquo; (Respondent 1, \u0026para;49)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The management is responsible for assuring the supply of vital medical devices, which are frequently unavailable, and understands their importance.\u0026rdquo; (Respondent 2, \u0026para;52)\u003c/p\u003e\n\u003cp\u003eA culture of engaged leadership and collaboration encourages accountability and ensures that resources and support systems are consistently available to maintain high EBP standards.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Encourage leaders at all levels to champion EBP initiatives, ensuring that they allocate resources and support necessary for successful implementation.\u0026rdquo; (Respondent 10, \u0026para; 95)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The administrative side also plays an important role by supporting these efforts.\u0026rdquo; (Respondent 15, \u0026para; 46)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130429\"\u003e\u003cstrong\u003eSub-theme 5.3: Individual motivation and commitment to EBP\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIndividual commitment and motivation are critical to integrating EBP into daily practice. A supportive environment that empowers and recognizes healthcare professionals was noted as a key factor in promoting adherence to EBP. Respondents emphasized that personal dedication to EBP enhances patient care, job satisfaction, and proactive engagement with evidence-based decisions.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;When healthcare professionals collectively accept the significance of such evidence, it encourages a proactive approach to data management.\u0026rdquo; (Respondent 10, \u0026para;76)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The success of evidence-based practice (EBP) is clear in how it helps transform patient care and achieves favourable outcomes.\u0026rdquo; (Respondent 6, \u0026para; 38)\u003c/p\u003e\n\u003cp\u003eA collaborative culture where evidence is created and shared reinforces individual commitment to EBP. Respondents highlighted the role of senior staff in championing EBP and inspiring broader adherence across departments \u003cstrong\u003e(see Figure 4).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Active involvement of senior staff in promoting and practicing EBP encourages broader adherence and integration throughout the hospital.\u0026rdquo; (Respondent 3, \u0026para; 54)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Encourages staff to actively engage in evidence creation and application.\u0026rdquo; (Respondent 12, \u0026para; 49)\u003c/p\u003e\n\u003ch2 id=\"_Toc184130430\"\u003eTheme 6: Challenges and Barriers to adherence to EBP\u003c/h2\u003e\n\u003cp\u003eAdherence to Evidence-Based Practice (EBP) faces numerous challenges that hinder its full integration into healthcare settings. These barriers exist at individual, institutional, and systemic levels, limiting the consistent application of EBP principles in clinical practice.\u003c/p\u003e\n\u003ch2 id=\"_Toc184130431\"\u003e\u003cstrong\u003eSub-theme 6.1: Individual-level barriers (lack of knowledge, negative attitudes)\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIndividual-level barriers such as knowledge gaps, resistance to change, and negative attitudes significantly hinder the adherence to Evidence-Based Practice (EBP) among healthcare professionals. Many practitioners lack a thorough understanding of EBP or perceive it as an additional burden rather than an integral aspect of their responsibilities. These barriers are further compounded by ingrained habits and insufficient motivation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge Gaps and Resistance to Change\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral respondents emphasized the lack of adequate education and awareness about EBP as a primary challenge. Some practitioners do not perceive gathering and utilizing evidence as part of their clinical duties, leading to inconsistent application. For instance, one respondent noted:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If healthcare professionals do not view gathering and using information as part of their work, they may be less inclined to adopt EBP in their clinical practice\u0026rdquo; (Respondent 6, 35:24).\u003c/p\u003e\n\u003cp\u003eReliance on traditional practices and expert opinions was also highlighted as a barrier:\u003c/p\u003e\n\u003cp\u003eReliance on expert opinion can also be problematic\u0026rdquo; (Respondent 7, 36:38).\u003c/p\u003e\n\u003cp\u003eWithout adequate knowledge and training, healthcare professionals struggle to integrate EBP into their routines, viewing it as an optional rather than essential component of patient care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNegative Attitudes and Lack of Motivation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNegative attitudes towards EBP were another recurring theme. Many practitioners resist change, often due to a perception that EBP disrupts established workflows or adds to their workload. As one respondent shared:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Some staff may not prioritize EBP, seeing it as less important than other daily duties\u0026rdquo; (Respondent 6, \u0026para;55).\u003c/p\u003e\n\u003cp\u003eThis resistance is exacerbated by a lack of encouragement and support from leadership:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Without adequate motivation and encouragement from leadership, health professionals may struggle to engage with EBP initiatives\u0026rdquo; (Respondent 6, \u0026para;56).\u003c/p\u003e\n\u003cp\u003eA positive attitude was noted as a key enabler of EBP adoption. However, in its absence, ingrained habits and skepticism towards new practices impede progress:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;A positive attitude toward EBP makes its adoption smoother, but without it, professionals may resist\u0026rdquo; (Respondent 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdministrative Challenges and Systemic Impacts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents also pointed out that administrative resistance to new information could hinder the integration of EBP into clinical settings:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Administrative acceptance of new information is one of the biggest challenges health professionals faces when implementing EBP\u0026quot; (Respondent 7, 36:33 \u0026para;50).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;This attitude can hinder the integration of new practices and make it more difficult for EBP to become fully embedded in clinical settings\u0026rdquo; (Respondent 7, 36:40 \u0026para;52).\u003c/p\u003e\n\u003cp\u003eThese challenges are further illustrated in \u003cstrong\u003eFigure 5\u003c/strong\u003e, which presents a network analysis of administrative and systemic barriers to EBP adherence.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130432\"\u003e\u003cstrong\u003eSub-theme 6.2: Institutional barriers (lack of infrastructure, funding)\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eInstitutional barriers such as inadequate infrastructure, insufficient funding, and limited organizational support were frequently cited by respondents as significant challenges to implementing Evidence-Based Practice (EBP). These systemic issues hinder healthcare professionals\u0026rsquo; ability to consistently adopt evidence-based approaches, affecting both the quality and efficiency of care delivery.\u003c/p\u003e\n\u003cp\u003eInfrastructure Limitations\u003c/p\u003e\n\u003cp\u003eInadequate infrastructure, including limited access to diagnostic tools, internet connectivity, and physical resources, emerged as a prominent barrier. Respondents highlighted the unavailability of essential diagnostic equipment and modern technologies as a significant hindrance to EBP implementation:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The absence of sufficient diagnostic resources presents a major obstacle to the implementation of evidence-based practice (EBP)\u0026rdquo; (Respondent 1, 30:20 \u0026para;40).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The availability of modern diagnostic equipment, especially MRI machines, presents a significant barrier for medical professionals practicing evidence-based practice\u0026rdquo; (Respondent 2, 31:18 \u0026para;56).\u003c/p\u003e\n\u003cp\u003eAccess to updated guidelines is another critical issue. Without internet connectivity or hard copies of guidelines, healthcare professionals struggle to stay informed about best practices:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The absence of hard copies further emphasizes the need for internet connectivity\u0026rdquo; (Respondent 12, \u0026para;52).\u003c/p\u003e\n\u003cp\u003eInfrastructure challenges extend to incomplete data management systems, which impede decision-making:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Data compilation is vital for decision-making, but incomplete registration and lack of infrastructure impair this process\u0026rdquo; (Respondent 10, \u0026para;68).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Constraints\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBudget limitations were widely reported as a critical barrier to EBP. These constraints impact the procurement of diagnostic tools, implementation of training programs, and hiring of adequate staff:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Budget constraints can also pose a significant barrier\u0026rdquo; (Respondent 12, 51:30 \u0026para;70).\u003c/p\u003e\n\u003cp\u003eAdditionally, insufficient funding hampers the ability to maintain or upgrade infrastructure, further compounding the challenges faced by healthcare providers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorkforce Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHeavy workloads and inadequate staff-to-patient ratios were frequently cited as obstacles to prioritizing EBP. High demands on healthcare professionals limit their time and capacity to engage in evidence-based practices:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Inadequate staff-to-patient ratios and heavy workloads make it challenging to prioritize EBP\u0026rdquo; (Respondent 4).\u003c/p\u003e\n\u003cp\u003eA lack of ongoing training exacerbates the issue. Without continuous education and skill development, healthcare professionals struggle to stay updated on evidence-based guidelines:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Insufficient ongoing training can impede the effective application of EBP, as healthcare professionals need continuous education to stay updated with best practices\u0026rdquo; (Respondent 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Organizational and Leadership Gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents also identified limited organizational support as a key barrier. Poor incentives, lack of recognition, and minimal accountability diminish motivation to adopt EBP:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Incentives, acknowledgment, and accountability are lacking, which may have a negative effect on engagement and motivation\u0026rdquo; (Respondent 1: ).\u003c/p\u003e\n\u003ch2 id=\"_Toc184130433\"\u003e\u003cstrong\u003eSub-theme 6.3: Cultural or systemic resistance to change\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eResistance to adopting Evidence-Based Practice (EBP) is often rooted in both cultural and systemic factors, creating significant barriers to its implementation. These challenges stem from deeply ingrained beliefs, traditional practices, and organizational inconsistencies that hinder the seamless integration of evidence-based approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural Resistance to Change\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCultural norms and attitudes within healthcare institutions significantly influence EBP adoption. Respondents emphasized that longstanding reliance on traditional practices, particularly among senior professionals, creates resistance to updating care methods:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Resistance to change is a significant obstacle, as implementing EBP necessitates modifying long-standing practices\u0026rdquo; (Respondent 1).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Senior professionals may sometimes believe that their experience outweighs the importance of current evidence\u0026rdquo; (Respondent 7).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There is a tendency among professionals to adhere to traditional practices rather than adopting new evidence-based approaches\u0026rdquo; (Respondent 3).\u003c/p\u003e\n\u003cp\u003eThis cultural reluctance is further complicated by differences in local practices compared to global standards. Such cultural resistance delays the acceptance of EBP, particularly in settings where traditional practices are valued over emerging evidence. For example:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The treatments or guidelines used in places like America might not align with our system\u0026rdquo; (Respondent 15, 44:24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSystemic Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystemic challenges, including inconsistent policies, frequent management changes, and a lack of standardized guidelines, further impede EBP implementation. Respondents highlighted the absence of a unified framework for information exchange as a critical barrier:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Without a unified policy or protocol from national policymakers, the variations in information exchange among institutions can lead to inconsistencies in care\u0026rdquo; (Respondent 15, 44:32 \u0026para;57).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Additionally, with changes in management, the updating of standard treatment protocols is often delayed\u0026rdquo; (Respondent 13, 42:26).\u003c/p\u003e\n\u003cp\u003eFrequent shifts in leadership disrupt continuity, making it challenging to sustain EBP initiatives. Moreover, inconsistent policies across institutions create confusion and hinder the alignment of practices with evidence-based guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterplay Between Cultural and Systemic Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCultural and systemic resistance often interact, amplifying the challenges to EBP adoption. For instance, the reluctance of senior staff to embrace change may discourage management from enforcing updated protocols, further delaying EBP integration. Similarly, systemic delays in providing clear guidelines can reinforce reliance on traditional practices, creating a cycle of stagnation.\u003c/p\u003e\n\u003cp\u003eThese overlapping challenges are illustrated in \u003cstrong\u003eFigure 6\u003c/strong\u003e, which presents a summary of barriers to adherence to Evidence-Based Practice.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eTheme 7: Recommendations for Improving EBP Adherence\u003c/h2\u003e\n\u003ch2 id=\"_Toc184130435\"\u003e\u003cstrong\u003eSub-theme 7.1: Suggestions for better training and education\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eRespondents emphasized the importance of continuous training and education to keep healthcare professionals updated on the latest evidence-based practices (EBP). Rapid advancements in medicine necessitate ongoing learning to avoid reliance on outdated practices. Respondent 2 highlighted this by stating:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Given how quickly medicine is evolving, it\u0026apos;s important to acknowledge that procedures performed ten years ago might not be applicable today. To align with EBP, we need to constantly update our knowledge and procedures.\u0026quot;\u003c/p\u003e\n\u003cp\u003eRespondents recommended holding frequent, focused training sessions to help close the gap between theoretical understanding and real-world application. These were considered essential for fostering competence and self-assurance in medical personnel. Important findings include:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Changing attitudes and enhancing knowledge through regular updates and training can improve adherence to EBP\u0026quot; (Respondent 3, \u0026para;52).\u003c/p\u003e\n\u003cp\u003e\u0026quot;Ongoing awareness and education are essential; regular training sessions keep staff informed about the latest practices\u0026quot; (Respondent 4, \u0026para;46).\u003c/p\u003e\n\u003cp\u003e\u0026quot;Providing practical training opportunities allows healthcare professionals to apply EBP principles in real time\u0026quot; (Respondent 6, \u0026para;47).\u003c/p\u003e\n\u003cp\u003ePractical recommendations included expanding training on digital literacy, improving access to EBP resources, and facilitating peer-to-peer learning. For instance, Respondent 6 noted:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Facilitating experience exchange among professionals supports the effective implementation of EBP.\u0026quot;\u003c/p\u003e\n\u003cp\u003eRespondents also emphasized the importance of collaborative forums, such as seminars and annual meetings, to promote a culture of continuous learning. Respondent 12 suggested:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Promoting collaboration through seminars, meetings, and shared journals can establish a culture of continuous improvement.\u0026quot;\u003c/p\u003e\n\u003cp\u003eHowever, a lack of digital proficiency among staff was identified as a barrier to accessing and utilizing EBP resources effectively. Respondent 6 explained:\u003c/p\u003e\n\u003cp\u003e\u0026quot;A lack of proficiency in computer use and software applications prevents staff from accessing and utilizing electronic resources.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeveloping competence and confidence in clinical decision-making through EBP was seen as a cornerstone of improving patient care. Respondents noted:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Understanding the importance of EBP ensures that clinical decisions are based on the most recent research\u0026quot; (Respondent 1, \u0026para;55).\u003c/p\u003e\n\u003cp\u003e\u0026quot;A positive attitude toward EBP is crucial for effective clinical decision-making\u0026quot; (Respondent 4, \u0026para;52).\u003c/p\u003e\n\u003ch2 id=\"_Toc184130436\"\u003e\u003cstrong\u003eSub-theme 7.2: Need for policy changes or updated guidelines\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMany respondents called for updated organizational policies and standardized guidelines that integrate current evidence into routine care. They stressed the importance of aligning national and institutional protocols to improve adherence to EBP. Respondent 1 recommended:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Effective implementation of initiatives like Ethiopian Hospital Alliance for Quality (EHAQ) and Evidence-Based Care (EBC) is crucial to increase adherence to EBP.\u0026quot;\u003c/p\u003e\n\u003cp\u003eClear and regularly updated policies were seen as essential for maintaining consistency in practice. Respondent 14 suggested:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Encouraging healthcare professionals to read and understand guidelines, such as the Ethiopian Hospital Service Improvement Guideline (EHSIG) and EBC protocols, enhances knowledge and commitment to EBP.\u0026quot;\u003c/p\u003e\n\u003cp\u003eRespondents also identified the need for a centralized platform to provide easy access to updated guidelines, research publications, and protocols. For example:\u003c/p\u003e\n\u003cp\u003e\u0026quot;To achieve a standardized national framework, collaboration among healthcare stakeholders is vital to create comprehensive and evidence-based guidelines\u0026quot; (Respondent 15, \u0026para;44:33).\u003c/p\u003e\n\u003cp\u003e\u0026quot;Providing easy access to journals and research publications empowers health professionals to stay informed and engaged with EBP\u0026quot; (Respondent 15, \u0026para;44:41).\u003c/p\u003e\n\u003cp\u003eThe lack of accessible platforms for obtaining manuals and guidelines was seen as a significant barrier. Respondent 13 noted:\u003c/p\u003e\n\u003cp\u003e\u0026quot;There is a lack of accessible platforms for obtaining manuals at every location.\u0026quot;\u003c/p\u003e\n\u003cp\u003eAdditionally, respondents suggested tailoring national guidelines to local needs by incorporating hospital-specific quality improvement (QI) projects. Respondent 1 explained:\u003c/p\u003e\n\u003cp\u003e\u0026quot;By adding hospital-specific QI projects to national guidelines, we have successfully created and executed local protocols.\u0026quot;\u003c/p\u003e\n\u003cp\u003eRespondents emphasized that frequent updates to policies and guidelines are necessary to keep pace with changes in evidence and practice. Respondent 13 remarked:\u003c/p\u003e\n\u003cp\u003e\u0026quot;If changes occur frequently or rapidly, prompt updates are essential.\u0026quot;\u003c/p\u003e\n\u003ch2 id=\"_Toc184130437\"\u003e\u003cstrong\u003eSub-theme 7.3: Recommendations for improving leadership and support systems\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOne of the most important suggestions for developing an Evidence-Based Practice (EBP) culture was to improve organizational support and leadership. The necessity of mentorship, active training engagement, and leadership that values cooperation and knowledge exchange was often emphasized by respondents. It was believed that leaders play a key role in fostering an atmosphere that supports EBP and inspires staff members to pursue ongoing education and skill improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePromoting a Culture of Learning and Collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLeadership was frequently described as the cornerstone for establishing a culture of continuous learning. Respondents emphasized the importance of fostering teamwork, open communication, and ongoing development. Leaders are expected to encourage health professionals to adapt to advancements in healthcare practices and actively support EBP adherence.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Fostering an environment that prioritizes continuous learning and adaptation\u0026rdquo; is vital to make EBP more engaging and practical (Respondent 7: \u0026para;36:54).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Health professionals must cultivate patience and a willingness to share their EBP knowledge with colleagues,\u0026rdquo; underscoring the role of leaders in building a collaborative environment (Respondent 14: \u0026para;43:22).\u003c/p\u003e\n\u003cp\u003eRespondent 9 advocated for\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Fostering a culture of continuous improvement in healthcare\u0026rdquo; as a sustainable approach to integrating EBP into everyday practice (Respondent 9: \u0026para;49:21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLeadership-Driven Support Systems\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe active involvement of leaders in implementing and sustaining EBP was recognized as fundamental. Respondents recommended establishing dedicated teams to regularly update guidelines and disseminate information effectively. They also stressed the importance of utilizing communication tools to enhance the accessibility of EBP resources.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The hospital effectively motivates adherence to evidence-based practice (EBP) by utilizing its own communication system to disseminate new information via platforms like Telegram,\u0026rdquo; noted Respondent 13 (\u0026para;42:15).\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;To ensure timely updates, there should be a dedicated team responsible for this task,\u0026rdquo; added Respondent 13 (\u0026para;42:27).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddressing Systemic Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral respondents pointed out systemic barriers, such as resource constraints, excessive workloads, and outdated systems, that hinder healthcare professionals\u0026rsquo; ability to implement EBP effectively. Leadership was seen as crucial in addressing these challenges to create an enabling environment for evidence-based care.\u003c/p\u003e\n\u003cp\u003eRespondent 4 recommended addressing staffing levels, stating,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Improving the nurse-to-patient ratio allows healthcare professionals to focus more on implementing EBP without being overwhelmed by excessive workloads\u0026rdquo; (\u0026para;69).\u003c/p\u003e\n\u003cp\u003eRespondent 3 highlighted the need for better system design, suggesting that hospitals must have\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Functional and user-friendly systems that facilitate evidence-based care\u0026rdquo; (\u0026para;79).\u003c/p\u003e\n\u003cp\u003eRespondent 3 further emphasized overcoming resource constraints, stating,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Address and overcome resource constraints to ensure that necessary tools and support are available for effective EBP implementation\u0026rdquo; (\u0026para;78).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMentorship and Knowledge Sharing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents highlighted the importance of mentorship programs and professional experience exchanges to reinforce EBP principles. Leadership was urged to prioritize mentorship as a means of improving staff confidence and competence in EBP application.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Learning about these developments is crucial as traditional medicine moves toward evidence-based practice,\u0026rdquo; noted Respondent 2, emphasizing the role of leaders in bridging the knowledge gap (\u0026para;36:12).\u003c/p\u003e\n\u003cp\u003eRespondent 12 suggested that fostering collaboration among professionals through \u0026ldquo;seminars, annual meetings, and forums for sharing journals and publications\u003c/p\u003e\n\u003cp\u003e\u0026rdquo; Could promote a culture of continuous learning and improvement (\u0026para;50:32).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the facilitators and barriers to adherence to evidence-based practice (EBP) among healthcare professionals at Tirunesh Beijing Hospital. The findings revealed a variety of interconnected factors that either promote or hinder the effective implementation of EBP within this healthcare setting. Healthcare professionals identified several key facilitators and motivators that support their adherence to EBP in clinical practice. They also highlighted various barriers that impede EBP adherence, both at the individual and institutional levels. Key factors influencing the success or challenges of EBP adoption included the availability of training, institutional support, personal motivation, and a collaborative environment. These elements were discussed as critical to understanding the factors that facilitate or obstruct adherence to EBP among healthcare professionals in the hospital.\u003c/p\u003e \u003cp\u003eOne of the critical facilitators identified in this study is the availability of continuous professional development (CPD) and structured training for healthcare staff. The importance of CPD in keeping healthcare professionals updated with the latest EBP principles is well-documented in the literature. Respondents emphasized that regular training and clinical audits, along with sharing updated guidelines during clinical rounds, are essential strategies for ensuring that practices remain aligned with EBP standards. This is supported by literature that highlights the need for EBP experts, online support guides, and ongoing communication as facilitators of EBP (Literature (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). For instance, structured discussions and the availability of electronic education modules have been identified as important for promoting EBP, particularly in stroke rehabilitation and long-term care settings (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInstitutional support, including leadership involvement, resource availability, and structured support systems, plays a vital role in the successful implementation of EBP. In this study, participants highlighted the importance of management’s role in providing vital medical devices and ensuring that these resources are available to support EBP initiatives. This finding aligns with the literature, which emphasizes the significance of management support in creating a culture conducive to EBP. The availability of resources and strong leadership have been identified as crucial facilitators in various studies, including those focused on long-term care(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), stroke rehabilitation(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and healthcare professional views on barriers and facilitators to EBP (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The role of executive sponsorship and a strong governance framework also supports EBP implementation, as seen in Australian healthcare systems (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividual motivation and commitment are essential for the success of EBP. Participants in this study described the proactive approach that healthcare professionals take when they collectively recognize the importance of evidence in patient care. This observation is consistent with the literature, which highlights the significance of individual attitudes, self-efficacy, and the role of healthcare professionals' motivation in promoting EBP(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). For example, healthcare professionals who are motivated and committed to applying evidence to improve patient care are more likely to engage in knowledge-sharing practices and promote evidence-based interventions. Similarly, a collaborative approach fosters a culture of learning, contributing to the transformation of patient care and improved outcomes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA collaborative environment is another key facilitator identified in this study. The findings suggest that knowledge sharing and collaboration among healthcare professionals, especially through interdisciplinary teams, are vital in translating evidence into practice. Literature also supports this view, as it emphasizes the role of collaborative culture and team-based approaches in the successful implementation of EBP (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In particular, fostering a positive atmosphere and involving senior staff in promoting EBP has been shown to encourage broader adherence across healthcare settings (Literature 25, 29). Furthermore, the importance of relationship-building and ongoing communication within teams has been noted as essential for maintaining a collaborative approach to EBP (Literature (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e One of the major individual-level barriers to adopting EBP is the lack of knowledge among healthcare professionals, which prevents the effective application of evidence-based guidelines. Literature highlights this challenge, citing insufficient knowledge and understanding of evidence-based practices as critical issues. For instance, healthcare workers often lack familiarity with clinical guidelines and rely heavily on traditional practices (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Negative attitudes toward EBP further exacerbate the problem, leading to resistance to change. Senior staff are particularly resistant, perceiving EBP as irrelevant to daily practice (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Additionally, lack of motivation, often driven by poor leadership support, compounds this resistance (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInstitutional barriers such as inadequate resources, limited funding, and lack of infrastructure also hinder EBP adoption. Studies consistently emphasize how resource shortages—whether in diagnostic tools, technology, or financial investments—impede the implementation of evidence-based guidelines (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Furthermore, insufficient incentives and recognition for engaging in EBP contribute to disengagement among healthcare professionals, especially when paired with high workloads and inadequate staffing (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA lack of continuous training is another significant challenge. Many healthcare institutions fail to provide adequate educational programs, leaving professionals ill-equipped to implement updated guidelines(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCultural and systemic barriers also play a major role. Traditional practices and hierarchical beliefs often dominate clinical decision-making, creating resistance to EBP, especially in low-resource settings (Literature (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Senior professionals frequently prioritize personal judgment over research-based guidelines, perpetuating resistance(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Finally, systemic barriers such as inconsistent policies and lack of standardized guidelines disrupt EBP integration. Frequent leadership changes and policy misalignments create confusion, as noted in Ethiopian studies where imported practices failed to align with localhealthcare contexts (\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e–\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThis study explored the facilitators and barriers influencing adherence to evidence-based practice (EBP) among health professionals at Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. Through a qualitative phenomenological approach, insights from key informant interviews (KIIs) and focus group discussions (FGDs) revealed a comprehensive understanding of EBP adherence in this setting.\u003c/p\u003e\u003cp\u003eThe findings highlight that adherence to EBP is fostered by several key facilitators, including resource availability, collaboration and knowledge-sharing among professionals, and a collaborative culture that supports EBP. Development of protocols and guidelines, as well as education and capacity-building initiatives, further encourage professionals to integrate evidence-based guidelines into their daily practice. Additional factors like structured EBP frameworks, regular clinical audits, and timely updates enhance health professionals’ confidence in applying EBP. Moreover, support from institutional leaders, advocacy for EBP, and incentives for motivation create an environment that promotes a culture of EBP and positively impacts patient outcomes.However, there are certain barriers that make it difficult to adhere to EBP. Heavy workloads, inadequate staff-to-patient ratios, and frequent administrative resistance lead to high levels of busyness and hinder EBP integration. Practical limitations, such as insufficient diagnostic equipment, lack of computer skills, and power cuts affecting electronic medical records (EMR), further obstruct consistent EBP implementation. Attitudinal barriers, including resistance to change, lack of interest, and reliance on expert opinion over research-based guidelines, also diminish adherence. Additionally, resource constraints, limited training opportunities, and issues with hospital system compatibility complicate the routine application of EBP.\u003c/p\u003e\u003cp\u003eThis study underscores the need for a strategic approach to strengthen EBP adherence. Addressing these barriers through enhanced resource allocation, structured EBP frameworks, and regular professional training could significantly improve EBP integration. By cultivating a supportive institutional culture and minimizing administrative obstacles, healthcare facilities can create a more consistent application of evidence-based practices, ultimately enhancing patient outcomes and care quality. Future research should investigate targeted interventions for specific barriers, measure their impact, and explore the broader effects of EBP on healthcare delivery and patient satisfaction in similar settings.\u003c/p\u003e"},{"header":"Limitation and strength","content":"\u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e\u003cp\u003eLimited Generalizability: Since the study was conducted in a single hospital, the findings may have limited generalizability to other healthcare settings. Differences in institutional policies, resources, and staff composition in other hospitals may affect EBP adherence differently.\u003c/p\u003e\u003cp\u003eSample Size Constraints: Although the sample size of 27 for KIIs and 6 for FGDs was appropriate for a phenomenological study, a larger sample across multiple departments could have provided additional perspectives. This limitation may restrict the depth of insights into department-specific barriers and facilitators of EBP adherence.\u003c/p\u003e\u003cp\u003ePotential for Researcher Bias: As with many qualitative studies, the interpretative nature of phenomenological analysis may introduce some degree of researcher bias. While ATLAS.ti helped in organizing data, the analysis relied on subjective interpretations that could influence the findings.\u003c/p\u003e\u003cp\u003eContext-Specific Challenges in Data Collection: Conducting the study within the hospital setting presented logistical challenges, such as scheduling interviews with busy healthcare professionals, which may have limited the availability of some participants or influenced the depth of discussions in time-constrained sessions.\u003c/p\u003e\u003cp\u003eTechnology-Related Constraints: Although ATLAS.ti facilitated data management, the software's limitations in certain advanced analysis functions may have restricted some aspects of data interpretation. Access to updated versions with more features could have enhanced the analytical capabilities.\u003c/p\u003e\u003cp\u003e \u003cb\u003eStrengths\u003c/b\u003e \u003c/p\u003e\u003cp\u003eIn-Depth Exploration: The qualitative phenomenological design allowed for an in-depth exploration of health professionals’ experiences, perceptions, and attitudes toward evidence-based practice (EBP). This approach facilitated a comprehensive understanding of both the facilitators and barriers to EBP adherence in the specific context of Tirunesh Beijing General Hospital.\u003c/p\u003e\u003cp\u003eDiverse Data Collection Methods: Using both Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) enabled the study to capture a wide range of perspectives and insights. This diversity in data collection methods enriched the findings by incorporating individual experiences as well as group dynamics, which are crucial for understanding complex factors influencing EBP.\u003c/p\u003e\u003cp\u003eRigorous Data Analysis with ATLAS.ti: The use of ATLAS.ti software (version 9) for data analysis contributed to the systematic and organized handling of qualitative data. It facilitated the coding process and allowed for the in-depth analysis of themes, which enhanced the reliability of the findings.\u003c/p\u003e\u003cp\u003eTriangulation to Ensure Validity: The study employed methodological triangulation by integrating KIIs and FGDs. This approach provided multiple sources of evidence, which strengthened the credibility and trustworthiness of the findings.\u003c/p\u003e\u003cp\u003e Context-Specific Insights: Conducting the study at Tirunesh Beijing General Hospital provided valuable context-specific insights into EBP adherence among healthcare professionals in Addis Ababa. These findings are particularly relevant for similar hospitals under Addis Ababa city administration in Ethiopia, making the study valuable for informing hospital-specific interventions.\u003c/p\u003e\u003cp\u003e \u003cb\u003eRecommendation\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThis study identified several key facilitators and barriers influencing adherence to evidence-based practice (EBP) among health professionals. To improve adherence and foster a more supportive EBP environment, the following recommendations are proposed:\u003c/p\u003e\u003cp\u003e \u003cb\u003eInstitutionalize EBP Practices\u003c/b\u003e \u003c/p\u003e\u003cp\u003eHealth facilities should integrate EBP as a core standard within hospital policies. Creating structured EBP guidelines and protocols will provide a clear framework that guides health professionals in evidence-based decision-making. (Code: Establishment of Guidelines, Structured EBP Framework)\u003c/p\u003e\u003cp\u003e \u003cb\u003eEnhance Leadership Support and Advocacy\u003c/b\u003e \u003c/p\u003e\u003cp\u003eHospital leaders should actively promote EBP by showing commitment, allocating necessary resources, and encouraging staff to participate in evidence-based initiatives. Leadership support plays a crucial role in creating a culture where EBP is valued and applied consistently. (Code: Leadership Support, Support and Advocacy for EBP)\u003c/p\u003e\u003cp\u003e \u003cb\u003eRegular and Targeted Training Programs\u003c/b\u003e \u003c/p\u003e\u003cp\u003eTo enhance EBP knowledge and practical abilities, conduct thorough, continuous training sessions. Modules on critical appraisal, applying EBP in clinical settings, and adjusting to new findings should be part of this. Training programs should also be revised often to take into account the most recent findings in research and industry best practices. (Code: Comprehensive Training, Regular Training Updates, Provide Targeted Training)\u003c/p\u003e\u003cp\u003e \u003cb\u003eIntegrate EBP into Electronic Medical Records (EMR)\u003c/b\u003e \u003c/p\u003e\u003cp\u003e Incorporating EBP resources and guidelines within the hospital’s EMR system can help streamline access to evidence-based information during patient care. This integration encourages clinicians to use research-backed guidelines consistently, enhancing patient outcomes. (Code: Integration of EBP into EMR, System Compatibility)\u003c/p\u003e\u003cp\u003e \u003cb\u003eReduce Workload and Address Resource Limitations\u003c/b\u003e \u003c/p\u003e\u003cp\u003eReducing excessive workloads through better staff-to-patient ratios or additional hires could significantly improve the capacity for EBP adherence. Addressing resource limitations, such as providing diagnostic equipment and other essential tools, will also facilitate more consistent EBP application. (Code: Reduction of Workload, Overcoming Resource Limitations)\u003c/p\u003e\u003cp\u003e \u003cb\u003eEncourage Continuous Learning and Collaboration\u003c/b\u003e \u003c/p\u003e\u003cp\u003eFostering a learning environment where health professionals are encouraged to continuously update their knowledge is essential. Hospitals can establish regular seminars, clinical audits, and workshops to review new evidence and assess current practices. Promoting collaboration and knowledge-sharing across departments can enhance the adoption of EBP principles. (Code: Foster Continuous Learning, Collaboration and Knowledge Sharing, Regular Clinical Audits)\u003c/p\u003e\u003cp\u003e \u003cb\u003eShift from Traditional Practices to an EBP Model\u003c/b\u003e \u003c/p\u003e\u003cp\u003eEncouragement should be given to the shift from dependence on expert opinion or conventional knowledge to an evidence-based approach. Change resistance can be reduced by highlighting the advantages of EBP, such as improved patient outcomes and more efficient use of resources. (Code: Shifting from Traditional to Evidence-Based Practice, Address Reliance on Expert Opinion, Attitude Shift)\u003c/p\u003e\u003cp\u003e \u003cb\u003eImplement Incentive Programs for EBP Engagement\u003c/b\u003e \u003c/p\u003e\u003cp\u003eMotivation can be increased by creating rewards for medical personnel who actively use EBP. More adherence to EBP principles can be promoted by performance-based rewards, recognition initiatives, and career development opportunities. (Code: Incentives for Motivation, Encourage Active Participation)\u003c/p\u003e\u003cp\u003e \u003cb\u003eFocus on Compatibility with Hospital Systems\u003c/b\u003e \u003c/p\u003e\u003cp\u003eEnsuring that hospital systems and infrastructure support EBP is crucial. Regular assessments of system compatibility, including EMR and other digital tools, can help identify technical barriers to EBP adherence. This will facilitate smoother integration of EBP practices within daily routines. (Code: Hospital System Compatibility)\u003c/p\u003e\u003cp\u003e \u003cb\u003eSuggestions for Future Research\u003c/b\u003e \u003c/p\u003e\u003cp\u003eTo build on the findings of this study, future research should investigate the long-term impact of structured EBP frameworks and incentives on EBP adherence. Studies could also explore specific barriers, such as resistance to change, in other healthcare settings to develop targeted interventions for similar contexts. Furthermore, quantitative research could help quantify the influence of facilitators like leadership support and collaboration on EBP adherence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my sincere gratitude to the healthcare professionals at Tirunesh Beijing General Hospital for their participation and valuable contributions to this study. I am also deeply thankful to my husband for his unwavering support throughout the research and manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbigiya Zewde Biru conceived and designed the study, conducted the interviews, performed the data analysis, and drafted the manuscript. Dr. Trhas Tadesse Berhe provided substantial contributions to the study design, critical review of the analysis, and manuscript revision. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific funding from public, commercial, or non-profit organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought from the Institutional Research Review Board (IRB) of Yekatit 12 Medical College with protocol number RPO/57/24. Additionally, ethical clearance was obtained from the Addis Ababa Public Health Research and Emergency Management Directorate. Permission to carry out the study was also granted by the administration of Tirunesh Beijing General Hospital. Participation in the study was voluntary, and after a detailed explanation of the study purpose, written informed consent was obtained from all participants. Confidentiality and privacy were maintained throughout the data collection process. All procedures were performed in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WSJB. Evidence based medicine: what it is and what it isn\u0026apos;t. 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Clinicians\u0026rsquo; attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature. 2020;15:1-24.\u003c/li\u003e\n\u003cli\u003eShafaghat T, Imani Nasab MH, Bahrami MA, Kavosi Z, Roozrokh Arshadi Montazer M, Rahimi Zarchi MK, et al. A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study. 2021;10:1-14.\u003c/li\u003e\n\u003cli\u003eAlmazrou SH, Alfaifi SI, Alfaifi SH, Hakami LE, Al-Aqeel SA, editors. Barriers to and Facilitators of adherence to clinical practice guidelines in the Middle East and North Africa Region: A Systematic Review. Healthcare; 2020: MDPI.\u003c/li\u003e\n\u003cli\u003eFeyissa GT, Woldie M, Munn Z, Lockwood CJPO. Exploration of facilitators and barriers to the implementation of a guideline to reduce HIV-related stigma and discrimination in the Ethiopian healthcare settings: A descriptive qualitative study. 2019;14(5):e0216887.\u003c/li\u003e\n\u003cli\u003eYehualashet D, Eshetu A, Zeleke M, Gebremedihn M, Mengesha D, Mamo DJEM. Barriers to the Implementation of Evidence Based Medicine in Ethiopia: A Systematic Study. 2022;12:245.\u003c/li\u003e\n\u003cli\u003eWubante SM, Tegegne MDJIiMU. Evidence-based practice and its associated factors among health professionals in Ethiopia: systematic review and meta-analysis. 2022;32:101012.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Barrier Barriers, Facilitators, Evidence-Based Practice, Adherence, Qualitative Study","lastPublishedDoi":"10.21203/rs.3.rs-6925137/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6925137/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvidence-Based Medicine (EBM), first defined by Dr. David Sackett, is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Over time, the concept expanded to Evidence-Based Practice (EBP) to include all health professions, as outlined in the Sicily Statement, which also defines the necessary skills and educational qualifications to practice EBP effectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To explore facilitators and barriers to adherence to Evidence-Based Practice (EBP) among health professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA qualitative phenomenological study was conducted from April to August 2024. Data were collected through 27 Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with six healthcare professionals. Thematic analysis was employed to identify key themes, supported by triangulation, peer debriefing, and member checking to ensure reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBarriers to EBP adherence included administrative and systemic challenges, workforce issues, resistance to change, resource limitations, and infrastructure gaps. Facilitators included strong leadership, resource availability, accountability systems, and supportive environments. Effective implementation, monitoring, and quality improvement initiatives were also critical in promoting EBP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAddressing barriers and leveraging facilitators through a coordinated approach is essential to improving EBP adherence in routine healthcare.\u003c/p\u003e","manuscriptTitle":"Exploring Facilitators and Barriers to Adherence to Evidence-Based Practice among Health Professionals at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:00:34","doi":"10.21203/rs.3.rs-6925137/v1","editorialEvents":[{"type":"communityComments","content":1},{"type":"decision","content":"Revision requested","date":"2026-02-03T13:40:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-23T04:05:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T13:24:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119159183049791207369560593642780553550","date":"2025-11-10T05:35:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229400141057728720756111263886515403534","date":"2025-10-31T08:55:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16627554244451796001918638178098910320","date":"2025-10-25T09:31:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329157290563205489965684641256214650070","date":"2025-06-30T11:44:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T08:19:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-25T08:15:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T07:32:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T15:22:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-21T15:19:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0993d444-ff07-4ec6-867c-10cd5f83cdbb","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-26T13:23:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 09:00:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6925137","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6925137","identity":"rs-6925137","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}