This descriptive cross-sectional study explored KAP level of EBP among 1,396 HCPs, comprising pharmacists, nurses, and physicians, with notable differences across demographic and professional characteristics. HCPs holding at least a bachelor’s degree, who are in daily contact with other healthcare professionals and patients, and are currently part of the workforce, were invited to complete the questionnaire via SurveyMonkey. The platform allows only one attempt per email, ensuring no duplication of responses. To our knowledge, this is the first cross-sectional study evaluating knowledge, attitude, and EBP among physicians, nurses, and pharmacists in Egypt. In contrast to many earlier studies, which were often focused on a single profession and setting, this survey gathered many respondents from a variety of practice settings, specialties, and healthcare professions, giving a better picture of the general knowledge and application of EBP in Egypt.
In our study, the majority of pharmacist and nurse respondents were female, whereas most physician respondents were male. This could be attributed to the lengthy career pathway, societal pressures to prioritize family responsibilities, demanding work hours, frequent on-call duties—particularly in specialties like intensive care and emergency medicine and the extensive qualifications required to become a physician [26, 27].
Nurses were the youngest group while physicians were the oldest. This can be attributed to the shorter duration of formal education required for their profession. This allows nurses to enter the workforce at a younger age. They can begin their careers with bachelor’s degrees which take significantly less time to complete compared to the lengthy educational and residency requirements for physicians.
In contrast, physicians typically spend over a decade completing their education, including undergraduate studies, medical school, internships, and residencies, which delays their entry into the workforce. Additionally, nursing tends to have higher rates of career turnover or attrition due to factors such as burnout, the physical demands of the job, job dissatisfaction, and long shifts [28, 29]. This turnover often results in younger nurses entering the field to fill workforce gaps, lowering the average age of nurses.
Physicians tended to have more years of experience compared to other groups. This is due to their extended period of training, which often includes postgraduate specialization, fellowships, or sub specializations. This also explains why physicians have the highest percentage of postgraduate qualifications compared to other HCPS.
The current study findings identified most participants were aware of EBP with physicians (81.31%) showing the highest awareness, followed by nurses (66.89%) and pharmacists (56.85). However, fewer have actively participated in courses or workshops on the subject. This is consistent with a previous KAP study on EBM, which reported that while 94.7% of Egyptian physicians were familiar with the term EBM, only 37.3% had attended prior EBM training [13]. Similarly, a study conducted in Ethiopia among 115 healthcare professionals found that although 72% (83 participants) were aware of EBM, only 35% had attended a course or workshop on the subject [30].
On the same hand, participation in EBM-related courses was low across all groups, with physicians showing highest overall participation. This is possibly because physicians need post-graduate degrees for specialization, which often incorporates EBM principles. This is clearly reflected in the study sample where 64% of the physicians had a post-graduate degree, compared to 40% of the pharmacists and 28% of the nurses.
Physicians demonstrated superior understanding of key EBM terms such as ‘relative risk,’ ‘meta-analysis,’ and ‘RCTs’ compared to nurses and pharmacists, while no significant differences were observed for ‘confidence intervals.’ This finding aligns with the Saudi Arabian study, which reported variability in physicians’ understanding of statistical terms, with better comprehension of ‘relative risk’ and ‘absolute risk’ but lower understanding of ‘confidence intervals’ [19]. Similarly, another study from Egypt revealed that 48.7% of physicians understood ‘case-control studies’ well enough to explain them, followed by ‘randomized controlled trials’ (44.7%), ‘relative risk’ (40.7%), and ‘absolute risk’ (34.7%). However, understanding of ‘confidence intervals’ was lower, with only 24% able to explain the concept [13]. However, it contrasts with the Syrian study, which showed an overall low level of understanding of statistical terms, including ‘relative risk,’ ‘absolute risk,’ and ‘meta-analysis,’ among physicians.” [31].
The findings of this study also revealed that most of respondents in our survey showed a positive attitude towards EBP and believed that EBP improves patient outcomes, decreases healthcare costs in Egypt, and helps update knowledge more rapidly between different professionals. In addition, all groups supported integrating EBP into clinical practice, with physicians showing the strongest agreement (83.5%). Similar conclusions were drawn in earlier studies, such as the assessment at the National Liver Institute, which reported that most physicians held favorable attitudes toward EBP and acknowledged its role in enhancing clinical decision-making and patient care [13]. Likewise, Egyptian family physicians expressed strong beliefs in EBM’s benefits for clinical practice and healthcare outcomes [32]. Nationwide surveys in Taiwan among multidisciplinary teams, including nurses, pharmacists, and allied health professionals, further highlighted positive attitudes toward EBP, though barriers such as insufficient resources and training were noted [6]. Similarly, pharmacists acknowledged the utility of EBP but identified challenges like lack of time and training [33], while Egyptian nurses expressed generally supportive beliefs despite facing hurdles in EBP implementation [34].
Physicians were the most active in using EBP resources, such as PubMed and UpToDate, followed by pharmacists and nurses. This aligns with findings from Taiwan, where physicians were more skilled in conducting EBP and applying it in clinical decision-making compared to other professionals [6].
One study has revealed that EBP among Egyptian nurses was low because of the English language barriers and that Egyptian nurses rely on their personal experience to provide patient care rather than EBP [34]. Nonetheless, another study reported that Egyptian nurses highly agreed that they can search for the best evidence to answer a question however, there is no time for internet search during work [35]. These findings in earlier studies could explain why nurses have shown the least engagement with EBP resources.
The present study identified key barriers to the implementation of EBP among healthcare professionals, including the lack of EBP training courses, limited access to full-text academic journals due to high cost, and the expenses associated with implementing new treatments. Similar barriers have been reported in other studies. For instance, a study in Ethiopia highlighted a lack of EBP training and difficulties in accessing resources, such as internet and time constraints, as major challenges [36]. Similarly, a study conducted in Iran identified organizational barriers such as a shortage of nurses (78.3%), lack of internet access at the workplace (72.2%), and heavy workloads (70.0%) as significant challenges. On an individual level, the most prominent barriers included a lack of time to read literature (83.7%) and insufficient ability to work with computers, which hindered the implementation of evidence-based practice [37].
HCPs in this study were highly interested in dedicating time during working hours for research activities and attending educational sessions on utilizing research findings to implement EBP in the future. Lack of time and scarce communication between academic and clinical practice environments were the most common barriers reported in many studies [13, 34, 38,39,40,41].
The observed differences in EBP engagement among physicians, pharmacists, and nurses can be interpreted in light of their varying roles in clinical decision-making. Physicians typically serve as the primary decision-makers in patient diagnosis and treatment, which necessitates a stronger reliance on up-to-date evidence to guide practice. Pharmacists, particularly those in clinical settings, increasingly participate in therapeutic decision-making by offering evidence-based recommendations on drug therapy. Nurses, while critical to patient care and implementation of treatment plans, may have fewer opportunities to initiate therapeutic decisions, potentially influencing their reported use of EBP. These findings are consistent with previous studies that highlight how professional roles and scope of practice shape the integration of EBP in daily clinical activities [42, 43]. Nonetheless, promoting EBP across all healthcare professions remains essential to improving overall care quality and patient outcomes.
These results highlight significant differences in EBP awareness, training, and practice among HCPs, emphasizing the need for tailored interventions to enhance EBP adoption across professions.
Recommendations
Given the evident gaps in EBP training and awareness among healthcare professionals in Egypt, several recommendations can be made. First, targeted educational initiatives should be introduced across all healthcare disciplines, particularly for nurses and pharmacists, to improve EBP competencies such as critical appraisal and biostatistics. These could include integrating EBP modules into undergraduate and postgraduate curricula, as well as offering continuing professional development (CPD) workshops.
Second, healthcare institutions should prioritize creating a culture that supports EBP through administrative support, access to digital resources, and protected time for research and evidence consultation. Appointing EBP champions or mentors within clinical departments could facilitate practice change and peer learning.
Third, at the policy level, the Ministry of Health and educational accrediting bodies should consider mandating EBP training as part of licensing or re-certification processes. National guidelines promoting EBP use in clinical decision-making would help standardize practices across facilities.
Finally, future research should explore the barriers to EBP adoption in specific healthcare settings (e.g., rural vs. urban, public vs. private) and test the effectiveness of targeted interventions in improving EBP knowledge and uptake.
Limitations
The main limitation of this study is that it relied on a web-based survey, which may have restricted access to certain populations, particularly healthcare professionals with limited internet access or low digital literacy. The cross-sectional design also restricts our ability to make causal inferences about the relationships observed. Finally, self-reported responses may introduce social desirability bias, potentially affecting the accuracy of the data.
Theoretical implications
This study contributes to the growing body of literature on evidence-based practice (EBP) readiness by providing empirical data from a Middle Eastern context, specifically Egypt, which is underrepresented in existing research. The findings support existing theories that emphasize the role of professional roles, institutional support, and prior exposure to EBP in shaping readiness. Our results also highlight the need for culturally and contextually adapted EBP frameworks that account for local healthcare infrastructure and professional norms.
Practical implications
The findings of this study suggest a clear need for structured EBP training programs targeted at different healthcare professions, especially nurses and pharmacists who reported lower readiness scores. Healthcare institutions should invest in continuous professional development programs that include EBP as a core component. Additionally, policy makers should consider integrating EBP competencies into national licensing requirements and healthcare curricula to strengthen decision-making capacity and patient outcomes across the system.
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