A total of 660 staff across the four SEA-ORCHID countries were surveyed. Professions represented included 80 obstetrics and gynaecology (O&G) specialists, four neonatologists, 36 paediatricians, 158 postgraduate medical trainees, 263 nurses, and 119 midwives (nurses with midwifery qualifications included).
The participants were identified as 564 (85%) female and 96 (15%) male across the four participating SEA countries (Table ). The female gender dominated for all professions surveyed, with nurses represented by 263 (100%) females, closely followed by midwives with 118 (99%). The age range varied among the professions with an overall mean age of 36 ± 9 years. A mean of 9 ± 8 years practicing in participants' respective profession was represented (Table ).
Demographics: gender, age range and years practicing in profession across all four SEA countries (n = 660)
Of the overall participants, 368 (56%) commented that the type of in-service training usually offered at their institution was of technical or professional nature, rather than managerial or administrative. No in-service training was indicated by 66 (10%) and 13 (2%) did not know if training was offered. However, 201 (30%) indicated that both types (managerial or administrative and technical or professional) of in-service training were offered at their institution.
Access to IT services
In answer to the question of easy access to a computer at the workplace, 301 participants across all four SEA countries (46%) responded that they had access with broadband internet connection while 139 (21%) indicated that they had no access. However there were great variations between the countries. In Indonesia, 63 (50%) of all participants reported no access to computers and of the participants that did, 26 (21%) could not access the internet through their computer. Thailand had the highest reported access where 127 (84%) participants had easy access to a computer at work with broadband connection (Table ).
Access to computers and IT services by participating SEA countries and by profession (n = 660)
Of all the SEA participants with no easy access to a computer at their workplace, 114 (50%) indicated that the greatest difficulty was a limited supply of computers. The 'other' option was chosen by 14 (6%) participants where 7 (50%) described that the difficulty they had was due to their limited knowledge of how to use the computer or the available software on the computer.
Health Information and Resources
Participants across all four SEA countries indicated that the reason for consulting health information sources 'frequently' were for patient care (377, 57%), for teaching (216, 33%), for personal study (219, 33%) and for research (179, 27%).
Resources 'frequently' used for health information were text books (359, 54%), colleagues (212, 32%), journals (157, 24%) and resources from pharmaceutical companies (30, 5%). Resources 'sometimes' used were resources from pharmaceutical companies (438, 66%), journals (380, 57%), colleagues (347, 52%) and textbooks (278, 42%).
The internet was used as a resource for gaining health information by 409 participants (62%), who listed 46 websites, with the most popular website being http://www.google.com
129 (20%), closely followed by http://www.pubmed.nl
69 (10%), then http://www.pubmedcentral.nih.gov
62 (9%) and http://www.yahoo.com
50 (8%) (Table ). Across SEA, nurses were the least likely to use the internet for health information with 136 (52%) indicating 'never', followed by nurse-midwives and postgraduate medical trainees. When asked how much time participants actually spent reading health information on an average weekly basis, 180 (27%) indicated less than one hour, 290 (44%) 1–2 hours and 195 (29%) indicated 3 or more hours a week.
The four web sites used mostly for health information access by profession across SEA (n = 660)
All participants were asked if they had ever heard about evidence-based practice, evidence-based medicine or evidence-based care. Of the total number of survey participants, 385 (58%) had heard about the concept. This result differed considerably between countries and the health professions, with the data from individual countries showing that 114 (75%) of Thailand's clinicians had heard about EBP, 71 (66%) from the Philippines, 142 (51%) from Malaysia and 60 (48%) from Indonesia.
Among SEA health professionals the different groups who identified that they had heard about EBP were 94 (36%) nurses, 48 (40%) midwives, 134 (85%) postgraduate medical trainees, 71 (90%) O&G specialists, 34 (97%) paediatricians and 4 (100%) neonatologists (Table ). Of the participants that had heard about EBP, 291 (76%) opted to write down their personal definition. The answers varied considerably between participants; however the majority of responses indicated a lack of understanding of the EBP concept identifying it as clinical practice guidelines or something to do with research.
Heard about EBP, The Reproductive Health Library and The Cochrane Library by profession across SEA (n = 660)
The Cochrane Library
In relation to having heard about The Cochrane Library, 307 (47%) participants indicated that they had (Table ) with 156 (51%) of these having access to it. This is obviously related to on-line computer access and whether a subscription had been paid. However, of the participants that had access to The Cochrane Library, 28 (18%) indicated that they never used it, 30 (19%) used it once a year, 65 (42%) used it once a month, 28 (18%) used it once a week and 12 (8%) used it more than once a week. This was a consistent result across all four SEA countries. A question relating to whether participants found The Cochrane Library helpful was answered by 140 participants with 83 (59%) indicating they found it a helpful tool. The usefulness related to accessing systematic reviews (29, 47%) and to retrieving information for clinical practice guideline development (11, 18%). Of all the survey participants 311 (70%) indicated they had not attended a Cochrane Library workshop and 571 (81%) expressed interest in attending such a workshop. This was consistent across all four countries with a range of 79–85%.
The Reproductive Health Library (RHL)
Within the survey participants 177 (27%) had heard about the RHL and of these 83 (47%) had access to it (Table ). Knowing about the RHL varied considerably between countries. In Indonesia, 6 (5%) health professionals had heard about this on-line resource, in the Philippines 23 (21%), in Malaysia 25 (9%) and in Thailand 46 (30%). RHL is a free resource to low and middle income countries.
Only 70 participants answered the question on whether RHL tool is helpful in their practices of which 57% answered that it is useful but 43% answered it is useful sometimes. Both groups indicated the most useful section in the RHL were the systematic reviews (42, 60%). Of these 70 participants, 28 (40%) had attended a RHL workshop, mainly in Thailand. No participants in the Philippines or Malaysia and only two from Indonesia had attended a RHL workshop. Overall 572 (87%) of health professionals across SEA indicated an interest in attending a RHL workshop. This was consistent in all four countries with a range of 80–89%.
Clinical Practice Change
Of the survey participant 230 (35%) responded as having been involved in changing an established clinical practice. These results varied between the four SEA countries however with participant from Thailand indicating 112 (74%) had been involved, 36 (29%) in Indonesia, 72 (26%) in Malaysia and 10 (9%) in The Philippines. These participants were then asked to identify who initiated this change with 75 (33%) identifying that the change was initiated by the Head of the Department, followed by the respondent themselves (54, 23%), senior staff (46, 20%) and colleagues (37, 16%) (Table ).
Who initiated changing an established clinical practice by profession across four SEA countries (n = 660)
Participants were asked about their understanding of why the change was made. Across SEA, 125 (54%) participants responded that the change was initiated because of new evidence, 70 (30%) identified the change was made because new health technology was made available, 15 (7%) indicated the change was made due to a new pharmaceutical drug and 16 (7%) did not know the reason for the initiated clinical practice change. Minor and major resistance to changing clinical practice was reported by 158 (69%) participants with the major reason being no discussion at implementation stage (67, 42%). This was followed by identifying additional resistance to change as no or little consultation (39, 25%), difficulty in accessing new clinical guidelines (28, 18%) and the observation that people did not like change or held on to their different clinical opinions and beliefs (15, 9%).
Participants were invited to identify possible enablers to overcome the barriers that were identified in the previous question. The major recommended action was discussion groups within professional groups (76, 48%) from inception right through to implementation. Easy access to clinical practice guidelines were identified by 31 (20%) participants and multidisciplinary workshops by 30 (19%). Overall, a local language was not identified as needed for enabling change or overcoming barriers. However, 16 (10%) of Thailand's participants indicated that translation of clinical practice guidelines would be useful.
Professional Development Indication
Participants were invited to indicate their interest in attending workshops on evidence-based health care and to provide suggestions for workshop topics as this could assist their professional development. Across all four SEA countries the majority of health professionals surveyed were interested in attending such workshops with a range from 550 (83%) to 578 (88%) (Table ). Additional topics for workshops were suggested by 9 participants, mainly related to computing skills and internet searching.
Workshops interested in attending by health professionals across four SEA countries (n = 660)
It is of interest to the SEA-ORCHID project to understand if there are reasons that would prevent participants from attending the workshops for professional development. The survey data showed that 211 (32%) participants had no concerns, 353 (53%) had concerns and 101 (15%) indicated that maybe there were concerns. Of those that identified concerns, 271 (41%) indicated they needed financial support but none was available, 260 (39%) felt they were too busy with their clinical workload and 182 (28%) indicated language as a barrier. Other barriers were indicated by 14 people with the two main reasons being difficulty in obtaining permission from Head of Department and difficulty in changing shifts.