Table 4.

Use of information results of qualitative observational studies

ID	Reference	Qualitative findings
8	Agbo et al 25	‘ No copy of the National policy guideline on malaria treatment had been seen or used by the health personnel and none had ever attended any training in form of workshop or seminar on malaria. ’ ‘Health workers identified challenges to efficient work as inadequate manpower, lack of materials like current national policy guidelines on disease management especially those commonly seen at the grassroots, lack of blood pressure measuring apparatus, erratic power supply, dilapidated structures and inadequate training opportunities. ’
126	Oduor et al 26	‘Clinicians reported the use of various sources of information as they looked up drug information, guidelines, and other medical content required to support patients. For example, a clinician described the tools he used to learn more about new drugs when asked about his source of information regarding recommended drugs: “My information sources are many. For example, I can read about new drugs from government circulars or from MEDS (Mission for Essential Drugs and Supplies) who are also ISO certified and have a laboratory where they conduct rigorous tests on their drugs. MEDS is accessible online [ via desktop computers or mobile phones]”. ’ ( P2, Clinician ) ‘ Clinicians also relied on various information sources to make decisions on which drugs to prescribe. These included the official government drug index booklet (Drug-Index.IT), the M edscape website, the OMNIO medical resources website and Ministry of Health guidelines. ’
41	Reynolds et al 27	‘Some participants referred to guidelines when describing what they would prescribe to a patient with malaria, particularly those patients considered to be special; for example, young children or pregnant women. Thus, it appeared that guidelines were largely interpreted as tools to inform the prescription of medicines following a malaria diagnosis, rather than to inform the process of diagnosis itself. ’
53	Perwaiz Iqbal and Rahman28	‘Most of the general practitioners were not aware of screening guidelines for close contacts of Tuberculosis patients. The WHO guidelines for Management of Tuberculosis are used in South Asian countries. However, the Pakistan Chest Society has published its own guidelines under the name of National Tuberculosis Guidelines, which are different from WHO. The general practitioners were using one or the other and somewhat confused as to which guidelines to follow.’
49	Park et al 7	‘Irrespective of location [hospital vs. clinic vs. health post], most health care workers utilized books and ministry of health resources such as protocols, workshops, guidelines, and the Internet, and some in hospitals and clinics used specific sites such as Google, Medscape, eMedicine Wikipedia, and WebMD. Several problems were identified with these sources including outdated information, un-usability of resources under pressing circumstances [ i e, patient is critically ill ], and discrepancies between known and trusted sources of information. Books were mostly considered outdated and considered too time-consuming to consult during patient care. Ministry of Health materials, including protocols, policies, guidelines, workshops, and lectures were frequently referenced but also considered largely outdated, as some facilities had National Treatment Guidelines dating back as far as 2007. Reported discrepancies between Ministry of Health resources included differences in choice of Malaria prophylaxis, Zinc Sulfate dosages required for treatment of diarrhea. ’ ‘The most notable challenge raised involved applying the available resources to current practice, as workers noted the clear disconnect between protocols and the “ reality on the ground ”. Another challenge was the conflicting nature of different sources of information, which often led to confusion and loss of trust in making clinical decisions. For instance, there was confusion over initiating Malaria prophylaxis for travelers within Botswana and it was not until the standard protocol was posted that a consensus was reached. This was particularly true for Internet based sources, as one hospital-based nurse stated, “The websites … we don’t know which one to use because … there are no recommendations to which one we are supposed to use ”. ’ ‘Opinions on Wikipedia as a potential clinical tool were split amongst healthcare workers in hospitals and clinics. For those familiar, Wikipedia was seen as reliable, useful, and helpful given its quick accessibility for searching for up to date information. Those who viewed its utility as conditional felt that they needed evidence of its accuracy including qualifications for writers. Those who viewed Wikipedia as unreliable felt that it should never serve as the primary source for clinical care or research. Suggested improvements to facilitate its use included an established, prior screening process by the Ministry of Health and restrictions on posting and sharing information. Additionally, requested features included increasing its relevancy specific to Botswana, offline accessibility, and Setswana translations of articles. ’