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Comparison of accessing online databases betweenphysicians and nurses in Taiwan
Ya-Wen Chiu, 1,2 Yi-Hao Weng, 3 Heng-Lien Lo, 4 Ya-Hui Shih, 1 Chih-ChengHsu1 & Ken N. Kuo1,4
1Division of Preventive Medicine and Health Services Research, Institute of Population HealthSciences, National Health Research Institutes, Miaoli, Taiwan, 2School of Public Health, Collegeof Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan, 3Chang GungMemorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, and 4Centerfor Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
AbstractOnline databases have been increasingly used as a key resource in the search for health information.The current study aims to compare the use patterns of online databases between physicians andnurses. A structured questionnaire was mailed to physicians and nurses of randomly selectedregional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians mademore use of online databases than nurses ( p < 0.001). They more often accessed English-language online databases ( p < 0.001), including MEDLINE, MD Consult, UpToDate, CochraneLibrary and ProQuest. On the other hand, nurses accessed Chinese-language online databasesmore frequently than physicians ( p < 0.001). Using a multivariate logistic regression model toadjust the personal characteristics, we found that nurses more often accessed Chinese-languageonline databases than physicians. Physicians used online databases to locate health informationthe most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research(57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) andclinical practice (55.8%). In conclusion, the behavior and motivation of access to online databasesvaried between physicians and nurses. Our findings provide evidence in the strategies to enhancethe accessing of online databases.
Keywords: Databases; evidence-based; nurses; online; physicians
1. Introduction
Numerous publications demonstrate that the Internet has changed information-searchingbehavior [1–6]. In the past, health professionals sought information from colleagues,pocket notes, printed textbooks and journals. Now, however, Internet has become thekey resource in the search for health knowledge [7]. Nevertheless, concerns have beenraised regarding the quality of information retrieved from the Internet [8]. In addition tothe dubiousness of its reliability, the amount of information is always greater thanneeded. In recent years, there has been a shift in attention from a focus on health
Correspondence: Ken N. Kuo, Division of Preventive Medicine and Health Services Research, Institute ofPopulation Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County35053, Taiwan. Tel: +886 37 246 166 ext. 36383. Fax: +886 37 586 261. E-mail: [email protected]
Informatics for Health and Social Care, December 2012; 37(4): 230–241Copyright © Informa UK LtdISSN 1753-8157 print/ISSN 1753-8165 onlineDOI: 10.3109/17538157.2012.654842
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knowledge to evidence-based information [9]. Clinical practice based on scientific evi-dence has been identified as a core competence to improve healthcare quality [10–12].Therefore, how to obtain current evidence-based knowledge from the Internet is an impor-tant issue.
One of the common Internet-based resources is the online database, defined as a data-base accessible from the Internet. Online databases offer easy access to obtain relevanthealth information with a summary of individual research evidence. Healthcare pro-fessionals can save time and facilitate clinical decision-makings by accessing the online da-tabases [13,14]. A growing number of empirical studies have demonstrated that theutilization of online databases can improve care quality [13–15]. Many institutions arebuilding substantial collections of access to various online databases. Thus, knowinghow to use online databases is a critical skill for locating evidence-based information.
Physicians and nurses are the two important health professionals in clinical service.Mastery of acquisition of evidence-based information is as important to physicians as itis to nurses. Differences in the backgrounds between physicians and nurses lead to differ-ent perceptions regarding evidence-based practice [16–18]. Because the resources of evi-dence-based databases come at a great cost, it becomes essential to gain a betterunderstanding of such discrepancies in the use patterns between physicians and nurses.The purpose of this study was to compare the behavior of accessing online databasesbetween physicians and nurses using a nationwide survey of representative samples.
2. Methods
2.1 DesignA structured questionnaire was developed by the Division of Health Policy Research andDevelopment, Institute of Population Health Sciences, National Health Research Insti-tutes, Taiwan. The questions in this survey were designed by modifying a previous ques-tionnaire [7]. The study was conducted during a 4-month period from November 2008through February 2009.
2.2 SubjectsThe targets in this study were physicians and nurses working in Taiwan’s regional hospi-tals. A regional hospital is defined as a secondary care hospital accredited by Taiwan’s JointCommission of Hospital Accreditation. In Taiwan, there are a total of 65 regional hospitals,among which 61 hospitals with around 5,000 physicians and 20,000 nurses were success-fully enrolled in a collaborative project with the National Health Research Institutes.Among the enrolled hospitals, we randomly selected 13 hospitals for the present study, in-cluding 4 located in northern part of Taiwan, 3 each in eastern, southern and western part.The postal questionnaire was distributed to all staff of selected hospitals. Respondents withthe title of either medical doctors or nurses were collected respectively.
2.3 QuestionnaireThe survey included items for examining such background characteristics as gender, age,faculty position, administrative position, working experience and academic degree. Theuse patterns of four Internet-based resources were measured: (1) Web portals (e.g.Google, Yahoo), (2) electronic textbooks, (3) online databases, and (4) electronic journals.The frequency was classified by Likert’s four-point scale (always, often, seldom and never).In addition, the questionnaire explored the usage (defined as access at least monthly) andmotivation of access to eight commonly used online databases: two databases in Chineseand six databases in English.
Comparing physicians’ and nurses’ usage of online databases
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(A) Chinese databases1. Index to Chinese periodical literature (ICPL) (www.ncl.edu.tw)The database contains
over 700,000 articles from approximately 2,600 titles of Chinese and Western languageperiodicals published in Taiwan, Hong Kong andMacau from 1991. Retrieval for recentarticles can be done under article title, author, class code, keyword, journal title, pub-lication date, etc. ICPL is supported andmaintained by the Periodical Section of ReaderServices Division of the National Central Library of Taiwan, which makes it availablefreely.
2. Chinese electronic periodical services (CEPS) (www.ceps.com.tw)CEPS providesmainly full-text Chinese-language articles published in Hong Kong, mainland Chinaand Taiwan. There are more than 2,000 periodicals for medicine, life science andnature science in Chinese and English. Most articles are collected since 1991. This da-tabase is browsed in Chinese and renewed daily.
(B) English databases
1. Cumulative index to nursing and allied health literature (CINAHL) (www.ebscohost.com/cinahl)This database focusses upon nursing and related professions. Journals,health care books, nursing dissertations, selected conference proceedings, standardsof practice, educational software, audiovisuals and book chapters are included. Over10,000 articles were indexed in more than 2,900 works published from 1981 to thepresent. The database provide browsers in multiple language, including a Chineseedition.
2. Cochrane Library (www.thecochranelibrary.com)This is the preeminent online data-base of systematic reviews containing regularly updated evidence-based healthcareinformation. Since the beginning of 2007, the National Health Research Institutes hasoffered the regional hospitals of Taiwan free access to the systematic reviews of Co-chrane Library [19].
3. MD Consult (www.mdconsult.com)This database covers full-text articles from over 50leadingmedical references across awide range of specialties, more than 80 clinical jour-nals, practice guidelines, clinically relevant drug information, and over 10,000 patienteducation handouts, and daily medical updates.
4. MEDLINE (www.ncbi.nlm.nih.gov)This is an international literature database estab-lished by the United States National Library of Medicine at the National Institutes ofHealth. It contains more than 16 million references in the fields of medicine, nursing, pharmacy, dentistry, veterinary medicine, health care, biology and biochemistry. Itcan be accessed via PubMed without charge.
5. ProQuest (www.proquest.com)The database consists of billions pages of global con-tents, including historical newspapers, dissertations and uniquely relevant resources.ProQuest Medical Library has over 1,000 titles in full text with abstracts and indexingfrom the MEDLINE.
6. UpToDate (www.uptodate.com)This database is a clinical reference designed toprovide access to current peer-reviewed information. Topic reviews are written byexperts who review the literature and then synthesize the information into specific rec-ommendations for diagnosis, management and therapy.These eight databases were selected based on the popularity [7,20–22]. Overall, ICPL
and MEDLINE are freely accessible. In addition, the other six databases are accessedwith charge from individuals or organizations.
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2.4 Validity and reliabilityContent validity was examined by nine experts with more than 15 years of clinical experi-ence each. The internal consistency of all indexes was estimated by using Cronbach’s coef-ficient alpha based on 50 pilot test data. In this survey, the content validity index of 0.98 andCronbach’s coefficient alpha of 0.81 indicated sufficient validity and reliability of par-ameters in the questionnaire.
2.5 Ethical considerationsThe study had the permission of the Ethical Review Board of the National Health ResearchInstitutes. The questionnaire was accompanied by an introductory letter stating thepurpose of this study and promising confidentiality. Return and completion of the ques-tionnaire were considered as indicating consent to participate in this study.
2.6 Statistical analysesThe statistical analyses were conducted using a commercially available program (SAS 9.1.3service pack 2). Significance was defined as p < 0.05. Pearson’s chi-square test was used tocompare the differences between physicians and nurses. Logistic regression analyses wereused to adjust personal characteristics, expressed by odds ratio (OR) and 95% confidenceintervals (CI).
3. Results
3.1 Data collectionA total of 5,147 questionnaires were distributed and 2,975 questionnaires were returned(response rate: 57.8%). Valid questionnaires with complete answers for analysis were2,117 subjects, including 544 physicians and 1,573 nurses (valid rate: 71.2%). Eighthundred and fifty-eight questionnaires were excluded because of incomplete answers.
3.2 Demographic characteristics between physicians and nursesThe demographic data of physicians and nurses are summarized in Table I. Physicians andnurses had divergent characteristics. Nurses were predominantly female (99.1%). In con-trast, only 97 (17.8%) physicians were female. The average age of physicians (39.3 ± 9.2
Table I. Demographic characteristics of respondents.
Physician (N = 544) Nurse (N = 1,573) p
Female (%) 17.8 99.1 <0.001Age (years) (mean ± SD) 39.3 ± 9.2 34.8 ± 6.5 <0.001Faculty (%) 39.3 20.2 <0.001Administrative member (%) 24.8 17.7 <0.001Working experience (%) <0.001
< 5 years 31.4 0.45–10 years 23.7 35.3> 10 years 44.9 64.3
Academic degree (%) <0.001Under college 0 75.4College* 80.2 20.3Master 15.6 4.0PhD 4.2 0.3
*College curriculum is 7 years for medical school and 4 years for nursing school.
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years old) was higher than that of nurses (34.8 ± 6.5 years old). The work experience ofnurses was significantly longer than that of physicians (p < 0.001): 64.3% of nursesworked for over 10 years and only 44.9% of physicians had work experience of morethan 10 years. In addition, having a position as a faculty member was more common inphysicians (39.3%) than nurses (20.2%) (p < 0.001). Similarly, having a position as anadministrative member was more common in physicians (24.8%) than nurses (17.7%)(p < 0.001). Furthermore, physicians tended to have higher additional academicdegrees than nurses (p < 0.001). Approximately three quarters of nurses did not have abachelor’s or higher degree. In order to determine whether there was a bias after excludingincomplete answers, comparison of demographic information between questionnaireswith complete and incomplete answers was performed. Analysis indicated that the demo-graphic information of the 2,117 enrolled subjects had no significant differences from thatof the 858 participants excluded.
3.3 Use patterns of the Internet-based resources between physicians and nursesThe usage of Internet-based resources for medical information is illustrated in Table II.
Physicians most frequently used Web portals and online databases. Approximately 84%of physicians often or always accessed Web portals and online databases. Electronic jour-nals were the third commonly used resource for physicians. Electronic books were usedthe least; approximately 60% of physicians seldom or never used it. On the other hand,nurses most frequently usedWeb portals, followed by electronic journals, online databasesand electronic books. About 40% of nurses always accessed Web portals for health infor-mation, but only less than 20% of nurses always used the other Internet-based resources.More than a half of nurses seldom or never used online databases. When comparedwith nurses, physicians more frequently used all four Internet-based resources: Webportals (p = 0.002), online databases (p < 0.001), electronic journals (p < 0.001), andelectronic books (p < 0.001).
Table II. Use patterns of the Internet-based resources, comparing 544 physicians and 1,573 nurses.
Resource Physician Nurse p
Web portals (%) 0.002Always 45.4 39.4Often 38.1 36.6Seldom 14.7 21.7Never 1.8 2.3
Online databases (%) <0.001Always 38.4 14.3Often 44.9 28.5Seldom 15.8 45.8Never 0.9 11.4
Electronic journals (%) <0.001Always 27.6 17.6Often 42.5 33.6Seldom 26.8 41.2Never 3.1 7.6
Electronic books (%) <0.001Always 11.2 6.7Often 28.1 22.3Seldom 47.1 49.8Never 13.6 21.2
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3.4 Awareness of availability for the online databases between physicians and nursesThe awareness of availability for eight commonly used online databases was illustrated inTable III. Physicians perceived the most commonly available database as MEDLINE(96.3%), followed by ICPL (87.7%), the Cochrane Library (79.0%),MDConsult (78.9%), Up-ToDate (76.8%), CEPS (67.6%), ProQuest (54.2%), and CINAHL (43.6%). On the otherhand, nurses perceived the most commonly available database as ICPL (94.5%), followedby CEPS (84.6%), MEDLINE (61.9%), CINAHL (58.0%), UpToDate (53.0%), the CochraneLibrary (52.8%), ProQuest (52.4%), and MD Consult (51.0%). When compared withnurses, physicians were better aware of MEDLINE (p < 0.001), UpToDate (p < 0.001),the Cochrane Library p < 0.001), and MD Consult (p < 0.001). In contrast, nurses werebetter aware of ICPL (p < 0.001), CEPS (p < 0.001), and CINAHL (p < 0.001). Therewas no significant difference in the awareness of ProQuest between physicians andnurses (p = 0.46).
3.5 Utilization of the online databases between physicians and nursesTable IV summarizes the access to eight commonly used online databases among phys-icians and nurses. Physicians accessed MEDLINE (94.9%) the most, followed by MDConsult (72.2%), UpToDate (71.3%), the Cochrane Library (68.6%), ICPL (61.8%), CEPS(50.0%), ProQuest (44.1%), and CINAHL (33.3%). In addition, nurses used ICPL (86.3%)the most, followed by CEPS (80.0%). They accessed the other online databases consider-ably less: MEDLINE (43.4%), CINAHL (36.2%), ProQuest (31.9%), UpToDate (31.3%), theCochrane Library (29.6%), and MD Consult (27.9%). When compared with physicians,nurses more often accessed Chinese-language online databases, including ICPL(p < 0.001) and CEPS (p < 0.001). In contrast, physicians more often accessed fiveEnglish-language online databases – the Cochrane Library (p < 0.001), MD Consult(p < 0.001), MEDLINE (p < 0.001), ProQuest (p < 0.001), and UpToDate (p < 0.001) –than nurses. There was no significant difference in the access to CINAHL betweenphysicians and nurses (p = 0.21).
3.6 Logistic regression analysis for access to the online databasesIn order to adjust the variables of personal characteristic, we incorporated five variables –age, clinical experience, faculty position, administrative position and academic degree – fora multivariate logistic regression model (Table V). Gender was not incorporated due to ahigh collinearity to professional specialty. Nurses more often accessed ICPL (OR = 3.965,95% CI = 1.964–8.003), CEPS (OR = 5.444, 95% CI = 2.790–10.623), and CINAHL
Table III. Awareness of availability for eight commonly used online databases among 544 physicians and1,573 nurses, in percentages.
Database Physician Nurse p
In ChineseICPL 87.7 94.5 <0.001CEPS 67.6 84.6 <0.001
In EnglishCINAHL 43.6 58.0 <0.001Cochrane Library 79.0 52.8 <0.001MD Consult 78.9 51.0 <0.001MEDLINE 96.3 61.9 <0.001ProQuest 54.2 52.4 0.46UpToDate 76.8 53.0 <0.001
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(OR = 8.005, 95% CI = 4.085–15.685) than physicians. In contrast, nurses less oftenaccessed Cochrane Library (OR = 0.319, 95% CI = 0.162–0.629), MD Consult(OR = 0.317, 95% CI = 0.172–0.585), MEDLINE (OR = 0.044, 95% CI = 0.02 –0.094)and UpToDate (OR = 0.260, 95% CI = 0.135–0.499) than physicians.
3.7 Reasons to access online databasesA total of 539 physicians (99.1%) and 1,394 nurses (88.6%) used the online databases. Theirmotivations to use online databases are shown in Table VI. Physicians used online data-bases most frequently for clinical practice (76.6%), followed by instruction preparation(63.3%), research (57.0%), personal interest (47.9%), class assignments (34.0%), medicalaccreditation (13.4%), and contests for evidence-based practice (8.4%). In addition,nurses accessed online databases the most for class assignments (66.4%), followed by re-trieving information for clinical practice (55.8%), instruction preparation (38.9%), personalinterest (29.8%), contests for evidence-based practice (23.2%), research (18.4%), andmedical accreditation (13.4%). When compared with nurses, physicians more often ac-cessed online databases for the following four purposes: clinical practice (p < 0.001), in-struction preparation (p < 0.001), personal interest (p < 0.001), and research (p < 0.001).However, nurses more often used online databases for class assignments and for conteststhan physicians (p < 0.001). There was no significant difference in the motivation formedical accreditation between physicians and nurses (p = 0.97).
Table IV. Access (in percentages) to eight commonly used online databases among 544 physicians and1,573 nurses.
Database Physician Nurse p
In ChineseICPL 61.8 86.3 <0.001CEPS 50.0 80.0 <0.001
In EnglishCINAHL 33.3 36.2 0.21Cochrane Library 68.6 29.6 <0.001MD Consult 72.2 27.9 <0.001MEDLINE 94.9 43.4 <0.001ProQuest 44.1 31.9 <0.001UpToDate 71.3 31.3 <0.001
Table V. The odds of access to the online databases for nurses versus physicians, adjusted by age,administrative position, faculty position, academic degree and working experience.
Database p OR 95% CI
In ChineseICPL <0.001 3.965 1.964–8.003CEPS <0.001 5.444 2.790–10.623
In EnglishCINAHL <0.001 8.005 4.085–15.685Cochrane Library 0.001 0.319 0.162–0.629MD Consult <0.001 0.317 0.172–0.585MEDLINE <0.001 0.044 0.021–0.094ProQuest 0.053 1.906 0.993–3.661UpToDate <0.001 0.260 0.135–0.499
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4. Discussion
This study depicts a nationwide profile of Internet use preferences of doctors and nurses atregional hospitals in Taiwan. As medical and nursing professionals are often busy withclinical practice, convenient access to instant knowledge is necessary [2,23]. The Internetdelivers time-efficient and cost-effective global information. The data demonstrate that theInternet represents a very important tool for them in the dissemination of health infor-mation. Universally, our participants accessed the Internet to search for health infor-mation. Our previous survey has indicated that all regional hospitals in Taiwan provideaccess to the Internet in the working place [7]. Furthermore, we demonstrate that the be-havior of Internet access was significantly different between physicians and nurses. To thebest of our knowledge, this study is the first survey to comprehensively compare the usepatterns of Internet-based resources between physicians and nurses in the hospital setting.
In our study, participants accessed Web portals most frequently. The findings are inaccordance with those of other studies [1,7,24]. With the advance of informatics, the useof Web portals is increasing [23]. By comparing our results with those of our survey in2007 [7], we found an increase in access to Web portals among physicians of regional hos-pitals in Taiwan. Web portals have been helpful for locating relevant information [25,26].However, inefficient searching and incorrect information remain the pitfalls of access toWeb portals [3,27,28]. Access to evidence-based recommendations through online data-bases can help overcome such problems [29].
Our study foundmajor discrepancies between physicians and nurses in access to onlinedatabases. The gaps in behavior and motivation were wide. We found physicians weremore likely to nominate an access to online databases than nurses. Our results are consist-ent with other studies [26,30–32]. In particular, our study has identified three main differ-ences between physicians and nurses in access to the online databases. First, MEDLINEwas the most frequently used database among physicians; but fewer than half of nursesaccessed it. Our study and Hider et al. [26] both show that physicians more often accessedMEDLINE and UpToDate than nurses did. Several studies have demonstrated thatMEDLINE has been the most commonly used database for physicians [33,34] but notfor nurses [35–37]. Second, nurses preferred to use Chinese databases, while physicianspreferred to access English databases. In Taiwan, almost all physicians are proficient inreading English since there is a common practice in Taiwan that all medical records arewritten in English; while nurses, on the other hand, customarily write nursing recordsin Chinese. Although use of online databases has been widely surveyed, few studieshave identified low level of English-language skills as a critical barrier [38,39]. This isnot surprising because participants in most studies have been native speakers ofEnglish. A multinational study, however, reveals that occupational physicians rate
Table VI. Motivation for the usage of online databases, in percentages.
Reason Physician (N = 539) Nurse (N = 1,394) p
Class assignments 34.0 66.4 <0.001Clinical practice 76.6 55.8 <0.001Instruction preparation 63.3 38.9 <0.001Personal interest 47.9 29.8 <0.001Research 57.0 18.4 <0.001Contests for evidence-based practice 8.4 23.2 <0.001Medical accreditation 13.4 13.4 0.97
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language as an important obstacle [38]. A survey in Japan shows that more than half ofhealth professionals perceived lack of English skill as a problem in locating evidence-based information [39]. These findings suggest that translating English databases intoChinese versions would help nurses in Taiwan find evidence-based information. And,third, nurses accessed the Cochrane Library the least. Although the Cochrane Library isa source aiming to promote systematic reviews, search difficulties for users remain unre-solved [40]. In order to enhance worldwide access to evidence from systemic reviews,having the Cochrane Library available in several languages may be needed.
In our survey, not all the databases discussed are available without charge in each hos-pital. The freely available databases for all hospitals include ICPL, CEPS, MEDLINE and theCochrane Library. Despite free availability, the awareness of availability differed betweenphysicians and nurses. We found the most recognizable database was MEDLINE for phys-icians, but ICPL for nurses. In addition, the awareness of availability is proportional to itsutilization. The higher awareness of availability, the more often access to the database [41].These results indicate that raising the awareness is a key element for facilitating its usage.
There are differences in the information needs to access online databases betweenphysicians and nurses. Our study demonstrates a greater proportion of physicians usedonline databases for clinical service, while nurses were more likely to report use forclass assignments. The findings are largely consistent with those from other relevantstudies [24,31,32]. The likely explanation is that doctors and nurses diverge in their clinicalroles. Hospital-based nurses rely mainly on clear directions, which are available from co-workers or booklets [42]. As a result, physicians and nurses require different resources tomeet their information needs. Since CINAHL is a database for nursing literature, phys-icians did not make more use of it than nurses [26,37].
Our study design included over 90% of all regional hospitals in Taiwan. These datatherefore represent a nationwide sample of regional hospitals and will be generalizableto physicians and nurses working in similar settings. There are some limitations to thisstudy. First, the response rate was only 57.8%. The gender and age of our respondentswere similar to gender and age composition in all regional hospitals in Taiwan, whichmay suggest that these two factors carried no significant difference between respondentsand non-respondents. Second, the included participants were 71.2% of total respondentsand we believe they were representative because their basic demographic characteristicswere similar to excluded respondents. Third, our study is a self-estimated survey anddid not explore the quality of information retrieved. It may not reflect actual behaviorfrom real-life situations. Therefore, the respondents’ understanding of critical assessmentof the evidence is not clear. It is difficult to measure the impact that the access to onlinedatabases has on clinical practice. Assessment of such impact on decision-making andcare quality has mostly relied on self-reported survey [26,43].
5. Conclusions and implications
Health professionals devote most of their time to patient care in the regional hospitals. Themajority of disease patterns they encounter are more complex than in primary care set-tings. Thus regional hospitals are medical facilities that need evidence-based informationsupport to improve the quality of healthcare.
Among the regional hospitals in Taiwan, there are significant discrepancies betweenphysicians and nurses in the preference and motivation in access of the online databases.Our survey concentrates on the use patterns of online databases. This study has raisedimportant issues that could be useful in clinical applications. First, our data represent a na-tionwide sample of regional hospitals in Taiwan. Second, we have demonstrated that the
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Internet is in widespread use among doctors and nurses. Third, physicians more oftenused English-language databases, whereas nurses preferred to access Chinese-languagedatabases. We believe language is a significant barrier in the utilization of online databasesfor Taiwanese health professionals, especially for nurses. Although improvement in com-prehension in English would be one method to help overcome the language barrier, ourresults suggest that translating English databases into mother-language versions wouldbe helpful in the dissemination of online databases. Establishment of Chinese-languageonline databases would also serve as another way to enhance access to evidence-basedinformation in Taiwan. Finally, motivation is a potential factor to access the online data-bases. We have distinguished that physicians tend to access online databases for clinicalpractice, instruction preparation and research; nurses tend to access online databasesfor class assignment and clinical practice. The data suggest that how to design a helpfulonline database should be strategically different for physicians and nurses. The resultsof our survey may extend to implications for other non-primary English-speakingcountries.
Acknowledgements
The authors express their gratitude to the participants who gave their time in this study.They are also grateful to Professor Chun-Yuh Yang for his encouragement and advice.This work was funded by a research grant (No. PH-098-SP03) from the National Health Re-search Institutes, Taiwan.
Declaration of Interest: None of the authors have any financial interests relevant to thisarticle to disclose.
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