Reference and Information Services Librarian, E. Latunde Odeku Medical Library, College of Medicine, University of Ibadan, Nigeria
Abstract
Background
The Internet is the world's largest network of information, communication and services. Although the Internet is widely used in medicine and has made significant impact in research, training and patient care, few studies had explored the extent to which Nigerian physicians use Internet resources for patient care. The objective of this study was to assess physicians' use of the Internet for health information for patient care.
Method
172 physicians at the University College hospital (UCH) Ibadan, Nigeria; completed a 31-item, anonymous, standardized questionnaire. The Epi-Info software was used for data analysis.
Results
The mean age of the respondents was 31.95 years (SD 4.94). Virtually all (98%) the respondents had used the Internet; 76% accessed it from cyber cafes. E-mail was the most commonly used Internet service (64%). Ninety percent of the respondents reported they had obtained information from the Internet for patient care; of this number, 76.2% had searched a database. The database most recently searched was MEDLINE/PubMed in 99% of cases. Only 7% of the respondents had ever searched the Cochrane Library. More than half (58.1%) perceived they had no confidence to download full-text articles from online sources such as the Health Internetwork Access to Research Initiative (HINARI). Multiple barriers to increased use of the Internet were identified including poor availability of broadband (fast connection speed) Internet access, lack of information searching skills, cost of access and information overload.
Conclusion
Physicians' use of the Internet for health information for patient care was widespread but use of evidenced-based medicine resources such as Cochrane Library, Up-to-date and Clinical Evidence was minimal. Awareness and training in the use of EBM resources for patient care is needed. Introduction of EBM in the teaching curriculum will enhance the use of EBM resources by physicians for patient care.
Background
The library and information science research community has carried out a substantial body of work examining health professionals' information needs, information seeking and use
Evidence-based medicine (EBM) is about solving clinical problems. It is an approach to clinical decision making that emphasizes data instead of opinion
Several studies have explored the use of the Internet to obtain clinical information for patient care by medical practitioners in diverse health institutions across the globe. For example, a 2004 study of resident physicians' adoption of information technology in Pennsylvania, United States, showed that 98% of the respondents used the Internet and two-thirds used it for health related purposes
The Nigerian health care sector is divided into three namely: Primary Health Care (PHC), Secondary and Tertiary services. Primary Health Care (PHC) is closest to the people and is constitutionally the responsibility of Local Governments (LGs). PHC services are available in rural and semi-urban centers in the country. In some rural communities, the PHC centers lack qualified medical practitioners and nurses provide services. Difficult cases that are beyond the health workers in PHC centers are referred to the nearest Secondary Health Care services in the area.
Secondary Health Care services are meant to take care of health problems that cannot be solved at the PHC level. Services at the Secondary Care are delivered in General or District hospitals under the supervision of the State governments. The General and District hospitals are located in towns and semi-urban centers with qualified medical practitioners that attend to patient's health problems. Some of the General and District hospitals do not have specialists to take care of rare and very difficult cases as a result; patients are referred to specialist hospitals located in capital cities.
The Tertiary Health Care service, which is the most sophisticated and costly for government and patients, are located in capital cities. These include University Teaching Hospitals and Federal Medical Centers as well as the National Hospital in Abuja. The Tertiary Health Care deals with the most difficult cases referred from Secondary Health Care services. There are many specialists in different fields of medicine at the tertiary health care level. All the university teaching hospitals in the country are also training institutions and are supervised by the Federal Ministry of Health
Both the primary and secondary health care services are available in rural communities and towns with limited or no access to Internet facilities. The tertiary health care are located in big cities where there is Internet connection however, many of the health workers do no have connection in their offices, in cases where there is connection to the Internet, epileptic power (electricity) supply is a major challenge.
Internet access is still a major challenge in Nigeria because the majority of people cannot afford the high initial cost of personal computers and connection fees. This has compelled most Nigerians to access the Internet via cyber cafes. Access to the Internet at home is not a common phenomenon as it is with cell phones. Cyber cafes are popular in Nigeria because access to the Internet is fee-based irrespective of where the service is used. Unfortunately, use of cyber cafes has several constraints including high cost of access, lack of privacy, and the fact that these cafes are typically rowdy. Other problems include the fact that several cafés do not install necessary software (e.g. Adobe Acrobat Reader) on their computers which makes it difficult for users to download or open documents/articles in Portable Document File (PDF) format. In some cafes, the computers do not have USB ports; some cafes have only few computers with functional floppy disk drives. As a result, downloading from the Internet into USB storage device (flash disc) and or floppy disk becomes impossible.
While previous studies cited above showed use of the Internet for clinical information for patient care by practitioners in developed countries, little is known about the extent to which their counterparts in developing countries use the Internet for patient care. This study was designed to fill this gap. The objective of the study was to determine the extent to which physicians' at the University College Hospital (UCH), Ibadan, Nigeria use the Internet to obtain health information for patient care.
Methods
The setting
The UCH, Ibadan, was established in 1957 and is the oldest federal institution for tertiary health care, teaching and research in Nigeria. The hospital has 45 medical specialties and subspecialties, runs 75 weekly consultative clinics and has 805 beds. Apart from providing care, UCH is also a major training institution for all categories of health workers in the country. Through the College of Medicine, University of Ibadan, UCH has trained over 5, 000 physicians and dentists and has produced approximately an equal number of scholarly publications of health-related research. The hospital itself has trained more than 6, 000 nurses and midwives since inception and several hundred other health professionals including medical laboratory scientists, teachers of community health, environmental health, medical records and radiography. To date over 12 million patients have received care in the hospital
Study population
The study population consisted of House Officers (HOs), Registrars (REGs) in residency training and Medical Officers (MOs) at the Staff Medical Services (Staff Clinic) and General Outpatient Department (GOPD) in UCH. The Staff Medical Services run daily consultative clinics for the staff of UCH and their family members and those of the College of Medicine and their families. The Staff Medical Services is a fully-fledged department in UCH and the patients consult MOs and specialists in General Practice (GP). All three categories of respondents (REG, MOs and HOs) were working in UCH between October and November 2005 when the study was conducted.
Measures
A 31-item anonymous questionnaire was designed and used to collect data for the study (See
Internet use by Resident doctors, Medical and House Officers for patient care. The document provided is a 31-item questionnaire used for data collection.
Click here for file
Recruitment and method of data collection
As part of preparation for the study, the investigator enumerated the physicians in residency (REGs), those on internship (HOs) and MOs by reviewing records kept at the Establishment/Personnel office in UCH. This revealed about 500 physicians available for study. The author obtained official permission to administer the questionnaire from Heads of Departments and Chief Registrars. The initial plan was to enroll all eligible physicians into the study. However, preliminary investigation showed that weekly meetings including Grand Rounds and Seminar Sessions were suitable avenues for reaching many of the REGs and HOs. Consequently, the dates and times of the meetings were recorded and the author attended the scheduled meetings between October and November 2005. During these meetings a total of 250 questionnaires were distributed to all eligible respondents (HOs and REGs) in attendance. It was administered to Registrars and HOs shortly before the meeting commenced and was collected after it was concluded. For MOs, the questionnaire was distributed to them through their Departmental office and completed questionnaires were kept there for the investigator to collect. Informed consent was given by return of completed questionnaire. The remaining 250 physicians were either on vacation or absent from the meetings as a result of busy schedules during the study period. Also, some of the physicians were on clinical rotation in other departments that did not grant the investigator permission to administer questionnaires to eligible respondents in their department.
Data analysis
The questionnaires were reviewed for completeness; they were collated and numbered serially. Open-ended questions were coded and were entered into the computer. Analysis was descriptive. The EPI-Info software developed by the Centre for Disease Control in Atlanta, Georgia, U.S.A. was used for data analysis.
Results
Of the 250 questionnaires distributed, 172 were completed and returned (response rate 69%).
Demographic profile of respondents
The demographic profile of the respondents is described in Table
Demographic profile of physicians in a teaching hospital in Ibadan, Nigeria (N = 172)
Variables
No
%
Age (in years)
25–30
68
39.5
31–36
83
48.3
37–42
16
9.3
43 and above
5
2.9
Gender
Male
116
67.4
Female
56
32.6
Current Status/Position
House officers
45
26.2
Medical Officers
23
13.4
Registrars
104
60.4
Faculty
Clinical Sciences
136
79.1
Basic Medical Sciences
27
15.7
Public Health
9
5.2
Total
172
100
Computer literacy and Internet usage
Respondents' computer literacy levels and Internet usage are presented in Table
Computer literacy and Internet usage among physician's in Ibadan, Nigeria
House Officers (N = 45)
Medical Officers (N = 23)
Registrar (N = 104)
Total (N = 172)
No
%
No
%
No
%
No
%
Are you computer literate?
Yes
41
91.1
22
95.7
97
93.3
160
93.0
No
4
8.9
1
4.3
7
6.7
12
7.0
Do you own a personal computer?
Yes
14
31.1
13
56.5
72
69.2
99
57.6
No
31
68.9
10
43.5
32
30.8
73
42.4
Ever used the Internet?
Yes
44
97.8
22
95.7
102
98.1
168
97.7
No
1
2.2
1
4.3
2
1.9
4
2.3
Used the Internet during the last week preceding the survey?
Yes
19
42.2
14
60.9
80
76.9
113
65.7
No
25
55.6
8
34.8
22
21.1
55
32.0
No Response
1
2.2
1
4.3
2
1.0
4
2.3
Do you have personal access to the Internet?
Yes
7
15.6
12
52.2
43
41.3
62
36.0
No
38
84.4
11
47.8
61
58.7
110
64.0
Main reason for using the Internet the last time.
34
75.6
11
47.8
62
59.6
107
62.2
Research
2
4.4
3
13.0
16
15.4
21
12.2
Health information
3
6.7
5
21.7
16
15.4
24
14.0
Patient care
2
4.4
1
4.4
6
5.7
9
5.2
Others
1
2.2
1
4.4
1
1.0
3
1.7
No response
3
6.7
2
8.7
3
2.9
8
4.7
Internet access points used the last time.
Office
1
2.2
5
21.7
14
13.5
20
11.6
Home
2
4.5
0
0.0
1
1.0
3
1.7
Library
3
6.7
1
4.4
14
13.5
18
10.6
Cyber café
3 8
86.4
16
69.5
73
70.1
127
73.8
No Response
1
2.2
1
4.4
2
1.9
4
2.3
Mode of Internet usage
Assisted
7
15.6
3
13.0
18
17.3
28
16.3
Not Assisted
37
82.2
19
82.6
84
80.8
140
81.4
No Response
1
2.2
1
4.4
2
1.9
4
2.3
Total
45
100
23
100
104
100
172
100
Respondents' were asked if they had personal access to the Internet; approximately one-third (36%) reported having Internet access while two-thirds (64%) had no access. Of the 36% who had personal access to the Internet, 52.2% were MOs. Respondents were asked which outlet they used in accessing the Internet the last time; a majority (76%) said they did so from cyber cafes. The majority (83.3%) claimed they used the Internet unassisted while someone assisted 17%. Respondents were also asked the main reason they used the Internet the last time; communication by email (65.2%) tops the list of reasons cited.
Use of health information and search engines
Respondents' use of health information on the Internet and search engines is presented in Table
Use of health information and search engines by physicians in Ibadan, Nigeria
House Officers (N = 45)
Medical Officers (N = 23)
Registrars (N = 104)
Total (N = 172)
No
%
No
%
No
%
No
%
Ever obtained health information from the Internet for patient care?
Yes
37
82.2
18
78.3
96
92.3
151
87.8
No
7
15.6
4
17.4
6
5.8
17
9.9
No Response
1
2.2
1
4.3
2
1.9
4
2.3
Search Engine used to obtain health information
Yahoo
17
37.8
6
26.1
34
32.7
57
33.1
23
51.1
13
56.5
63
60.6
99
57.6
Others
0
0.0
0
0.0
2
1.9
2
1.2
No Response
5
11.1
4
17.4
5
4.8
14
8.1
Used a Search Engine during the previous month?
Yes
25
55.6
12
52.2
80
76.9
117
68.0
No
19
42.2
10
43.5
22
21.2
51
29.7
No Response
1
2.2
1
4.3
2
1.9
4
2.3
Total
45
100
23
100
104
100
172
100
Use of databases for health information
Respondents' use of databases as sources of health information is presented in Table
Use of Databases for health information by physicians in Ibadan, Nigeria
Variable
House officers (N = 45)
Medical Officers (N = 23)
Registrars (N = 104)
Total (N = 172)
No
%
No
%
No
%
No
%
Ever searched a database
Yes
32
71.1
16
69.6
83
79.8
131
76.2
No
13
28.9
7
30.4
21
20.2
41
23.8
Which of these databases did you search the last time?
MEDLINE/PUBMED
32
71.1
16
69.6
82
78.8
130
75.6
Cochrane
0
0.0
0
0.0
1
1.0
1
0.6
No Response
13
28.9
7
30.4
21
20.2
41
23.8
Did you obtain relevant health information from the database for patient care?
Yes
25
55.6
15
65.2
71
68.3
111
64.5
No
20
44.4
8
34.8
33
31.7
61
35.5
Online Evidence Based Medicine sources ever searched.
Cochrane
2
4.4
2
8.7
8
7.7
12
7.0
Up-to-date
1
2.2
0
0.0
8
7.7
9
5.3
Clinical Evidence
7
15.7
7
30.4
13
12.5
27
15.7
Others
2
4.4
0
0.0
17
16.3
19
11.0
No Response
33
73.3
14
60.9
58
55.8
105
61.0
Total
45
100
23
100
104
100
172
100
Perceived confidence to perform Internet related tasks and problems encountered
The respondents' perceived confidence in performing six Internet related tasks is shown in Table
Perceived confidence of physicians to perform Internet related tasks
Tasks
House Officers (N = 45)
Medical Officers (N = 23)
Registrars (N = 104)
Total (N = 172)
No
%
No
%
No
%
No
%
Retrieve and download free medical books from the Internet
Yes
4
8.9
5
21.7
26
25.0
35
20.3
No
41
91.1
18
78.3
78
75.0
137
79.7
Search the Internet to find out how a particular clinical procedure is carried out
Yes
19
42.2
5
26.1
52
50.0
77
44.8
No
26
57.8
17
73.9
52
50.0
95
55.2
Search the Internet for the most current diagnostic test or therapy for a disease condition
Yes
26
57.8
18
78.3
69
66.3
113
65.7
No
19
42.2
5
21.7
35
33.9
59
34.3
Retrieve and download full-text articles from online journals, BJM; HINARI etc.
Yes
8
17.8
12
52.2
52
50.0
72
41.9
No
37
82.2
11
47.8
52
50.0
100
58.1
Find the most current available evidence to answer a clinical question relating to patients condition
Yes
24
53.3
12
52.2
66
63.5
102
59.3
No
21
46.7
11
47.8
38
36.5
70
40.7
Find information on the diagnosis, prognosis and treatment of an ailment
Yes
39
86.7
20
87.0
93
89.4
152
88.4
No
6
13.3
3
13.0
11
10.6
20
11.6
Total
45
100
23
100
104
100
172
100
The problems respondents encountered while using the Internet are presented in Table
Problems encountered searching the Internet by physicians' current status
House officers (N = 45)
Medical officers (N = 23)
Registrars (N = 104)
Total (N = 172)
No
(%)
No
(%)
No
(%)
No
(%)
Did you encounter any problem using the Internet?
Yes
27
60.0
14
60.9
65
62.5
106
61.6
No
18
40.0
9
39.1
39
37.5
66
38.4
Problems encountered
Slow Internet connection
20
44.4
9
39.1
46
44.2
75
43.6
Too much information
13
28.9
3
13.1
9
8.6
25
14.5
Cost of Internet Access
0
0.0
4
17.4
24
23.1
28
16.3
Lack information searching skills
12
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