Background: Numerous surveys of medical clinicians indicate that a variety of attitudinal, epistemic, logistic, and economic factors can mitigate against (or encourage) the implementation of evidence-based medicine (EBM).1-16 However, there have been few studies of clinician attitudes towards and knowledge of EBM in nonwestern clinical contexts.17-21 These few studies suggest that these same mitigating factors exist for medical decision-makers all over the world. In addition, infrastructural and organizational factors that often prevail in developing countries exacerbate barriers to implementing EBM in these areas. For example, nonwestern medical professionals doubted the applicability of Western medical information to their local healthcare contexts, but were also skeptical about the quality of research conducted in their own countries and regarded Western medical information as higher in quality.

Objective: Our objective is to survey clinicians in a variety of clinical settings throughout 28 countries located in Central and Eastern Europe and the former Soviet Union to determine their attitudes towards and understanding of the principles and procedures of EBM in nonwestern contexts. This survey is a part of a larger effort to compare on a multicultural scale clinician commitment to competing models of rationality (see Cronje et al. and Freeman et al. abstracts).

Methods: An online survey will be administered from April-June 2004 to clinicians working at hospitals and clinics affiliated with the American International Health Alliance (AIHA), a nonprofit organization that promotes the sharing of medical knowledge across partnerships between US medical institutions and institutions in 28 countries in Eastern Europe and the former Soviet Union. Most of the survey is also being administered to clinicians in the midwestern United States (see Freeman et al. abstract) to permit intercultural comparisons. Some of these questions have been rewritten to work within the AIHA-partnership contexts. Additional questions pertaining only to the AIHA context will also be included in the international version of the survey.

Respondents will be able to take the survey either in English or in Russian. Additional pilot testing (for both the English- and Russian-language versions of the survey) will be conducted in Croatia (English-language version) and Ukraine (Russian-language version).

Individual clinicians will be invited to participate in the survey with an email message that will provide the URL for the online survey. Non-respondents will be reminded to complete the survey using a series of follow-up email messages.

Qualitative analysis will be performed on questions that elicit narrative-type responses. Demographic characteristics of the respondents will be statistically compared to those of the general population, as well as to respondents in the midwestern United States. Chi-squared tests, tests involving differences of proportions, and other tests appropriate to testing the relationship among several (Likert scale) ordinal variables will be used to analyze the quantitative data.

Results: We anticipate we will be able to report information regarding clinician attitudes towards EBM and the epistemic principles that inform EBM, clinician knowledge of the terms and procedures of EBM, and clinician perceptions of institutional and logistic factors that impinge on their practice of EBM both within and across cultural contexts.

Acknowledgements: The authors wish to acknowledge the financial support of the American International Health Alliance and the University of Wisconsin Eau Claire.