title: Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.
abstract: BACKGROUND
  Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice.
  
  
  OBJECTIVE
  This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting.
  
  
  METHODS
  Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach.
  
  
  RESULTS
  Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings.
  
  
  CONCLUSIONS
  The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ranita
authors.initials: R
authors.lastname: Hisham
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Su May
authors.initials: SM
authors.lastname: Liew
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chirk Jenn
authors.initials: CJ
authors.lastname: Ng
authors.affiliation: Family Health Development Division, Ministry of Health, Putrajaya, Malaysia.
authors.forename: Kamaliah
authors.initials: K
authors.lastname: Mohd Nor
authors.affiliation: Klinik Kesihatan Jaya Gading, Kuantan, Pahang, Malaysia.
authors.forename: Iskandar Firzada
authors.initials: IF
authors.lastname: Osman
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Gah Juan
authors.initials: GJ
authors.lastname: Ho
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Nurazira
authors.initials: N
authors.lastname: Hamzah
authors.affiliation: Centre of Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008296:Malaysia; D008297:Male; D058007:Physicians, Primary Care / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D019035:Rural Health Services; D012424:Rural Population