Background: evidence hesitancy occurs when clinicians, policymakers or patients are hesitant about using best available evidence. The causes of evidence hesitancy have not been systematically documented but may be related to culture or resistance to change. Evidence hesitancy in consumers poses the biggest risk to evidence implementation because patients’ preferences and values are the bedrock of evidence implementation.
Objectives: to construct a framework of evidence hesitancy in consumers following an evidence communication intervention for the treatment of uncomplicated malaria in children under five years in Cameroon using grounded theory.
Methods: we used a contextualized approach of evidence translation and communication using storytelling, songs, poetry and drama to get evidence to community members in Cameroon. We used GRADEd evidence from Cochrane, Joanna Briggs Institute (JBI), World Health Organization, Ministry of Health Cameroon, and primary studies. We used a systematic approach developed at eBASE Africa to translate evidence with artists: PICO development, searching evidence, considering GRADE, ensuring communication occurs with artists, and modeling evidence into arts. We organized two performing arts events with La Liberté Arts Group and a Cochrane-affiliated consumer group in 2018/19 with 1889 consumers attending. We conducted a post-event qualitative study using MAXQDA. We developed code systems around JBI’s FAME model for evidence translation. We used a single-case model with code hierarchy to demonstrate emerging themes.
Results: we identified seven emerging themes from code system constructions including evidence acceptance; evidence hesitancy; diversity needs; role of culture; evidence communication; evidence reaffirmation, and recommendations on the process. We developed 150 code systems. Ten per cent of code systems (n = 150) were related to evidence hesitancy with five subcodes. Modeling code system using single-case with code hierarchy suggests evidence hesitancy was related to inherent consumer doubts about research evidence, cost related to health technology required for evidence implementation, and non-availability of health technology required for evidence implementation. These categories were related to consumers insisting on doing things the 'old' way, assuming they already knew the evidence, justifying why evidence could not be used, making statements without facts or which were clearly false ,or contradicting their own statements. (Table 1 & Fig 1).
Conclusions: in an era of post- and alternative truth, evidence hesitancy plays a key role in consumers accepting what works. The current wave of vaccine hesitancy may have its roots in evidence hesitancy and must be addressed by global actors. In considering diversity it is important to consider culture, access, equity, and literacy levels.
Patient or healthcare consumer involvement: our project targets consumers and we collaborated with a Cochrane-affiliated consumer organization.