Globally, there is an increasing call for the use of evidence in health care to enhance patient outcomes.1,2 In Ghana, there is a great need for evidence utilization as the disease burden remains high, with increases in chronic and non-infectious diseases adding to the existing burden of infectious diseases, trauma and maternal and child health conditions.3 This escalation of disease burden is exacerbated by the unavailability of adequate resources.3 Furthermore, there have been situations of ineffective or inefficient treatments being used, thus wasting limited resources and placing an additional burden on the already overstretched health system. It is therefore crucial that practitioners caring for patients and health policy-makers not only know what the most cost-effective and up-to-date interventions are but are also able to implement them. Evidence utilization, which involves implementation of evidence into practice and policy, is greatly influenced by factors such as available research, resources, provider expertise/education and patient preferences.4 The ability of healthcare practitioners to adopt interventions that are research based is a key attribute of evidence-based practice that will enhance patient outcomes.5 Despite the relevance of evidence-based practice, evidence implementation in Ghana is plagued with various challenges.6

Globally, there has been an influx of efforts at developing research synthesis methods, conducting systematic reviews and designing structured ways of getting evidence into practice.1 However, at the provider level, a general lack of training on identifying, accessing and understanding evidence has been reported.6 For instance, among health professionals there exists difficulties in understanding statistical analysis and interpreting research findings, inadequate access to information technology (IT), limited IT skills and lack of information search skills.7,8 These lead to difficulties in systematically searching for, critically appraising and analyzing research evidence as well as determining the applicability and transferability of the evidence to better inform healthcare decisions.7 Although health professionals may consider themselves information literates, more work is required so they can practice their craft. Even for those with information literacy prowess, they are faced with the vast amount of healthcare literature which makes it problematic to identify the relevant components of the evidence to be implemented.8 This is further compounded by time pressures at the point of care as health care professionals are already overwhelmed by the number of patients they need to attend to. In some instances, practitioners may even come face-to-face with the evidence, but how to implement becomes a challenge - organizational support may be lacking or practitioners may lack relevant skills. Furthermore, there is poor collaboration between health care researchers and clinicians, as well as limited access to locally produced research. Both professions appear to have different priorities. The researcher is viewed as existing in a separate world by the clinician and vice versa. The end result is that a piece of research is published in an international scientific journal, but in reality, it will have little or no impact on the setting in which it was undertaken.

Another issue is the fear and uncertainty among health practitioners. The climate in most health facilities hardly permits change and practitioners will want to continue practicing the "old way", based on "how we have always done it" rather than challenging the status quo with evidence. Anyone who decides to implement evidence is likely to undertake the journey alone and face resistance from professionals who may not want to move out of their comfort zone. Compounding this issue is the fact that most facilities have existing protocols that are updated infrequently; this makes practitioners comfortable even though its rigidity stifles innovation. With the spectre of legal ramifications, everyone will want to "play it safe" and follow the protocol rather than attempt to implement something new. In addition, there is the lack of champions within our health system to inspire others to be innovative and lead change.

The patient brings to the mix his or her own personal preferences and unique concerns, expectations and values.9 However, we live and work in a setting in which patients hardly get the opportunity to indicate what their preferences are: they are often viewed as passive partakers in the care delivery process. The health system is so overstretched and burdened by limited resources that health professionals can hardly get to know what their patients' preferences, concerns, expectations and values are. This is further compounded by the existence of the National Health Insurance Scheme which has specific management guidelines for various conditions. Thus, the focus remains on what is available and not what the patient prefers as the latter implies higher out of pocket costs which the patient may not be able to meet. Thus, the "patient factor" appears rather blurred in the process.

In conclusion, it appears that even though health professionals perceive evidence utilization to be of importance, its implementation appears to be faced with enormous challenges. Health facilities and stakeholders need to develop policies that can create the right atmosphere for professionals to implement evidence. Also, health facilities need to be committed to evidence utilization and be ready to deal with the challenges associated with the process. There is also a need to empower patients to be active partakers of the care delivery process rather than passive recipients. In addition, health professionals need to receive adequate orientation in evidence-based practice so they can identify, access, understand and implement evidence.

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