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The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey
© Jones et al; licensee BioMed Central Ltd. 2007
Received: 07 June 2006
Accepted: 15 January 2007
Published: 15 January 2007
Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read.
We enquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice.
The same three information sources – professional meetings & conferences, peer-reviewed journals and medical colleagues – were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community.
No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs.
If medicine is to be evidence-based then health research findings need to be implemented appropriately in the clinical setting. However, there is an ever-expanding wealth of biomedical knowledge to be assimilated and used by clinicians [1, 2]. The range of potentially available information sources is large and even for one of them, peer-reviewed journals, the choice within a specialty is enormous.
A review of the information sources used and favoured by clinicians from many different medical specialties, as well as some nursing groups, found results varied from one study to another . Overall, however, other medical colleagues were the preferred source, for example Cullen found that family practitioners referred most frequently to medical specialists . In contrast, others found printed materials to be the favourite source [5–7]. Even studies on the implementation of a specific clinical advance show that a wide range of sources can all play a role .
Despite some doubts , journals continue to be considered an important information source by many clinicians. Journals are also still the principal medium used to publish research findings. Assessment of both research and journals can be contentious [10–15] and in the UK, there are moves within research assessment towards giving some recognition to the impact made by research [16, 17]. A key issue for researchers wishing to make their findings known to clinicians might be "Which information sources and journals are clinicians most likely to access and take notice of?"
These issues may well differ between specialties. Even within one specialty there are likely to be differences between different groups. The availability of different information sources, as reported by trainees-on-call, has been studied in relation to paediatric and neonatal units in UK hospitals . The survey reported here covers the general use of information sources by paediatricians, at consultant and non-consultant career grades (NCCG) within both hospital and community environments. We aimed to determine which sources are consulted or attended by UK paediatricians to inform their clinical practice and which are considered important. We also aimed to identify how many and which specific journals were read by clinicians. This allows comparisons with the journals containing the best paediatric evidence identified by Birken et al  and potentially provides information that could contribute to the assessment of research outputs.
Ethics approval was not required for this study as the survey was conducted anonymously using a list of names and addresses taken from the Medical Directory (see below) which is available in the public domain. Prior to the release of the Medical Directory, those listed are given the opportunity to exclude their names from external surveys.
The method used involved a questionnaire survey followed by analysis, comparisons within the specialty and further comparisons with other similar or related studies.
Questionnaire structure [see Additional file 1]
The questionnaire focused first on information sources in general and then concentrated on journals.
A list of 11 information sources was presented in the questionnaire. In compiling this list, advice was sought from members of the Royal College of Paediatrics and Child Health to ensure the inclusion of information sources likely to be available to community-based or hospital-based paediatricians. Questionnaire recipients were asked to tick any information sources that they consulted or attended to inform their clinical practice. They were invited to add and tick any that were not listed and from the complete list to rank the top three.
A list of journals was constructed including general medical, paediatric and sub-specialty journals either if they contained a large number of NHS funded paediatrics papers or if they scored highly on the impact factors developed by the Institute of Scientific Information (ISI, now part of Thomson Scientific). Thus the list was derived from two sources. Firstly from the Research Outputs Database (ROD)  and secondly from the Journal Citation Reports (JCR) 2002 from ISI  [see Additional file 1]. After overlaps were removed, the two sources resulted in a total of 39 journals that were listed in the questionnaire.
The questionnaire recipients were asked to tick up to ten journals in total that they read or consulted on a regular basis to inform their clinical practice. They were invited to add any that were not listed.
Further questions related to the position they held, the number of academic and clinical sessions they worked and their predominant role.
The data from the questionnaire survey were entered into a database for analysis using a double-entry procedure to ensure the integrity of the data. The names of journals added to the questionnaires by respondents were verified using Ulrich's International Periodicals Directory  or the internet.
The paediatricians' responses were collated and tabulated according to three criteria:
▪ their position (i.e. consultant or non-consultant career grade)
▪ whether or not they had academic responsibilities
▪ their predominant role (i.e. community-based, District General Hospital-based (DGH), working at the tertiary level)
A statistical analysis was undertaken to investigate the null hypotheses that the information sources accessed and the number of journals read were independent of the paediatrician's characteristics.
The characteristics of respondent paediatricians in the questionnaire survey.
Position and academic responsibility
All (n = 993)
Community-based (n = 294)
DGH-based (n = 412)
Tertiary (n = 279)
Non-consultant career grades
With academic responsibility
Information sources consulted or attended by respondent paediatricians to inform their clinical practice and those considered important
Journals read and considered important to clinical practice
For the number of journals read, the results reflect the greater importance of journals to academics than non-academics. 21% of respondents overall read three journals or less and 16% read 10 journals or more. Comparisons found significant differences at the 95% confidence level for the number of journals read by: consultants (mode 10+, median 6) versus NCCGs (mode 3, median 4, Chi-square test: = 97.85, p = < 0.001); academics (mode 10+, median 8) versus non-academics (mode 6, median 6, Chi-square test: = 70.43, p = < 0.001); and hospital-based consultants (mode 10+, median 7) versus community-based consultants (mode 3, median 5, Chi-square test: = 56.55, p = < 0.001).
The journals most widely read by different groups of respondent paediatricians
All paediatricians (n = 993)
Tertiary (n = 279)
DGH-based (n = 412)
Community-based (n = 294)
Journals read a
academic (n = 175)
non-academic (n = 807)
All, without NCCGs (n = 193)
bNCCGs (n = 101)
Archives of Disease in Childhood (UK)
Journal of Pediatrics (USA)
New England Journal of Medicine (USA)
Developmental Medicine & Child Neurology (UK)
Current Opinion in Pediatrics (USA)
Pediatric Clinics of North America (USA)
Child Care, Health & Development (UK)
Preferred information sources
In terms of the three measures used the overall picture across all respondent paediatricians indicated no one dominant source of information, but instead three were important. Furthermore, across all groups of paediatricians and for all situations studied, the picture was complex with no one source of information being the most important. Such findings highlight the need for careful analysis in terms of how to improve the flow of 'best evidence' to paediatricians.
The position of electronic databases perhaps highlights their potential for becoming increasingly important. They are down in sixth place for being consulted but, by both ranking measures used, they are placed fourth for importance. This might suggest that as their availability is increased, especially for paediatricians in the community, they will become an increasingly important source of information.
Riordan et al's study of information sources used by paediatricians-on-call in hospital units, mostly in training, found that guidelines and textbooks were most widely used and a few used the internet or journals. In our survey of the general use of information sources by consultants and NCCGs, journals were identified as, overall, the source ranked first, second or third most important by the highest number of paediatricians. In terms of being ranked first, however, 10% of non-academic community NCCGs ranked journals first, compared with 46% of tertiary academics doing so. Community NCCGs are also the only group for which medical education courses are ranked first by more paediatricians than are peer-reviewed journals (Figure 2). Clearly different dissemination strategies are likely to be most appropriate for the different groups and for different situations, but we have found that journals are confirmed as still being of considerable importance.
Individual peer-reviewed journals
There was a significant difference between the numbers of individual journals read by hospital-based paediatricians and by those based in the community. This finding reflects the preference for peer-reviewed journals as a general information source and may reflect the greater availability of journals to clinicians in hospitals. Two membership journals, Archives of Disease in Childhood and BMJ, were the most widely read by all three groups (community-based, DGH-based and tertiary) and only one other – Pediatrics – is read by more than 20% of all three groups. It therefore appears that there are a small number of key journals for dissemination.
Birken et al  also suggested a large proportion (~ 40%–60%) of the best evidence for paediatric clinical practice was found in a small number of journals. They listed seven journals that they found to be in the top ten most cited by all three different sources of best evidence for paediatric clinical practice and Riordan et al found that all seven of these 'best-evidence' journals were available at 80% or more of the UK paediatrics and neonatal hospital units studied . Overall, six out of these seven journals were the most widely read journals in our study (See Table 2) though in a different order to that suggested by Birken et al. A detailed analysis of the readership of the top six journals by different groups of paediatricians, reveals that all six journals are read by at least 40% of those who are DGH-based or tertiary, with or without academic commitments, but only two, Archives Of Disease In Childhood and BMJ, are read by more than 27% of any category of paediatricians based in the community. It appears then, that the variation in readership patterns for these seven journals containing 'best evidence'  is much greater than the variation in availability found in hospital units  and indeed the availability in the community is uncertain.
There was an even split (5:5) for the journals most widely read between those that are based in the UK and those that are based in the USA, with the top three based in the UK. This suggests a possible nationality bias but the issue of membership journals is a confounding factor.
Comparison of the findings from this survey of UK paediatricians with the survey of UK psychiatrists reveals many similarities . These include: the importance of a small number of journals; the dominance of the main membership journal from the respective royal colleges; and the apparent prominence of UK-based journals.
No one information source is dominant, therefore a variety of approaches to Continuing Professional Development should be used. Furthermore, given the variations different dissemination strategies for research findings are likely to be most appropriate for different groups of paediatricians. Overall, journals are an important information source for paediatricians and a small number of key journals can be identified, but the readership of specific ones varies within the specialty. By identifying the journals most read by clinicians to inform their clinical practice the findings could provide valuable additional input into the evaluation of clinical research outputs.
We gratefully acknowledge funding from the NHS Executive, London, for the NHS ROD Fellowship and from the Policy Research Programme of the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the funders. We also thank members of the Health Economics Research Group, Brunel University: Dr Stephen Morris and Hema Mistry for their assistance with the data analysis; Avril Cook and Nicky Dunne for their assistance with the questionnaire survey and analysis. We would also like to thank all paediatricians who responded to our questionnaire survey and the reviewers for their helpful and constructive comments.
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