Title Knowledge, attitude and use of evidence based practice (EBP) among Registered Nurse-Midwives practicing in Central Hospitals in Malawi: A Cross-Sectional Survey

Abstract Background: Even though EBP is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes and use of registered nurses-midwives practicing in central hospitals in Malawi. Methods: The descriptive, cross-sectional research design was conducted with a convenient sample of 183 nurse-midwives (response rate of 86%). The study used a questionnaire to collect data. Data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarize overall knowledge levels, attitudes and use of nurse-midwives as percentages based on their scores from the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson’s correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives. Results: The average scores (mean±SD) of evidence-based practice amongst nurse midwives were 78.7±19.6 for attitude, 70.6±15.1 for knowledge levels, 57.8±23.for use, and 68.9±14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P=0.02). Research experience was associated with higher scores in nursing use (P=0.005), and higher overall evidence based practice were associated with both research experience (P=0.035) and educational qualification (P=0.004). Nurse-midwives attitude was affected by clinical experience (P=0.006) and the hospital where nurse-midwives worked (P=0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals Conclusion: It is important to develop the knowledge/skills of nurse midwives in order to enhance evidence based practice amongst nurse midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, Ministry of Health policy makers, Nurses and Midwives Council of Malawi and donors to enhance implementation of EBP.