The study sought to examine the extent of use of evidence by frontline MNCH/RCH staff for practice decisions, as well as the factors that influence the use of such evidence. From the findings, the use of evidence for practice decisions had a score of 3.89 out a total of 5, with the use of both manual and online practice guidelines, protocols and policies as key sources of evidence. In terms of the factors that affect the use of evidence by frontline MNCH/RCH staff, attitudes of staff towards the use of evidence had the highest score (3.99), with organizational structure and processes to facilitate the use of evidence having the lowest score (3.57). The regression results further suggest that frontline MNCH/RCH staff’s attitude towards evidence-based practice, access to relevant information, knowledge of evidence-based practices in MNCH/RCH service provision and organizational structure and processes have a significant positive effect on the use of evidence by frontline MNCH/RCH staff. However, when socio-demographic characteristics of respondents (facility ownership, age, gender, education level, location, years of work and specialty of work) were introduced into the model, access to information remained positive but insignificant. Additionally, the results showed that an MNCH/RCH staff from a mission health facility, being a male and having worked for a longer time was significantly positively correlated with the use evidence for practice decisions.
The overall score of 3.89 out of a total of 5 for use of evidence by MNCH/RCH staff for practice decisions suggest that there is appreciable level of use of evidence by MNCH/RCH staff, although it can be improved. The challenge though is that evidence seems to be restricted mostly to the use of practice guidelines, protocols and policies. There may be the need to improve the skills of staff to also search for and use findings of professional and research literature to inform practice decisions. Within the literature, the use of research evidence does not seem to be as popular as practice guidelines, protocols and policies, given the complexities associated with the use of research-based evidence. Issues that have been raised include timeliness and relevance of research evidence to specific practice challenges, relationship between producers and users of evidence and the ability of users to adapt research-based evidence to their context [6, 20]. This may explain the reliance on practice guidelines, protocols and policies.
The results of the study resonate with findings from other jurisdictions (see systematic review by Humphries et al., ). Positive Attitudes of healthcare staff such as dieticians and therapist have been suggested as key inputs into evidenced-based practice decision making . There are also examples of physicians, occupational therapist and physical therapist whose positive attitudes towards the use of evidence has actually influenced the use of evidence in their practice [25–28]. It is important also to emphasise that there are instances where positive attitude of healthcare staff has not actually resulted in substantial use of evidence to inform practice decisions . The attitudes of healthcare staff towards the use of evidence is often informed by their perception of what is referred to as evidence  and is related to who is producing the evidence and whether it can readily be used in the practice of the healthcare staff [29–31].
The findings also suggest that practice -relevant research evidence is available and accessible to MNCH/RCH staff to some degree. Such availability and accessibility create opportunities for the implementation of strategies that can help to improve MNCH/RCH staff’s understanding of what constitute practice evidence, and consequently ensure that research findings take into consideration the reality of practice. This can be key in improving access to relevant information for evidence-based practice decisions. The difficulty in having access to relevant information for decision-making has also been identified in the literature as a barrier to the use of evidence [30, 32–34]. For example, issues of information overload, the time it takes for research information to be converted into a form that can be used by healthcare workers have been agued in the literature as constituting barriers to the use of evidence [28, 35, 36].
The findings also suggest that knowledge of evidence-based practices in MNCH/RCH is key to using evidence in practice decisions. However, apart from the confidence of staff in sharing and disseminating information with or to their colleagues, all the other indicators on knowledge of evidence-based practices by the MNCH/RCH staff interviewed had relatively lower scores and will therefore need some improvements. Effort to improve knowledge will ensure that staff have the requisite skill and experience needed to utilize available evidence to inform practice decisions. The existing literature suggest that healthcare workers have shortfalls in skills and experience especially in areas of research literacy and research utilization [29, 32, 37]. It is for example suggested that a weaker link that constrain the ability of healthcare workers to utilize evidence in practice decisions include low capacity to; acquire research, assess the reliability, quality, relevance and applicability of research findings and finally ability to summarize research evidence in a manner that can easily be used to inform practice decisions .
The results under organizational structure suggest that only 2 (i.e. basic values of continuous learning and a climate of openness, respect and trust among staff) out of the 14 indicators retained in the organizational structure constructs had higher scores. Although the scores of the other 12 indicators were not extremely low, the key message is that the other 12 indicators need some improvement. This will be essential in ensuring that the use of evidence to inform practice decisions among MNCH/RCH staff sees a significant positive change. For example, issues of research leadership, strong professional leadership that facilitate research, putting in place systems that encourages external learning and benchmarking and communication of key research priorities and strategies will be essential in this direction. Prior studies have argued that structural rigidities in organizations constitute key constraints to the use of evidence in decision-making . These rigidities manifest in constraints such as low numbers and skill of the required human resources [20, 34, 38], inadequate financial resources [29, 33, 35], workload issues and competing priorities , lack of organizational data and systems [34–36], poor senior management support for evidence-informed decision-making [30, 38], poor formal planning and intra-organisational communication [37, 38] and organizational processes that constraints evidence-informed decision-making [32, 37].