Abstract
BackgroundEffective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL).MethodsA cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop.ResultsThe design and implementation of a complex intervention using a cluster randomized trial design are presented.ConclusionDesigning the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change.
Highlights
Effective strategies for implementing best practices in low and middle income countries are needed
[3] This annually updated database includes predominantly Cochrane systematic reviews that are relevant to reproductive health problems faced in low-income countries together with commentaries written by experts familiar with under-resourced settings, short practical guidance documents and implementation aids to facilitate the implementation of recommended practices
Reproductive Health Library (RHL) is published in English and Spanish with new topics added and updated topics revised on an annual basis
Summary
Effective strategies for implementing best practices in low and middle income countries are needed. [3] This annually updated database includes predominantly Cochrane systematic reviews that are relevant to reproductive health problems faced in low-income countries together with commentaries written by experts familiar with under-resourced settings, short practical guidance documents and implementation aids (such as educational videos) to facilitate the implementation of recommended practices. The sixth issue of RHL published in 2003 contains 79 Cochrane reviews Initiatives such as RHL should address some of the information access and management difficulties faced by physicians. They are unlikely, by themselves, to lead to significant improvements in performance, as health care workers have limited time to read reviews and guidelines and many changes in behaviour require organisational changes. While there is no single intervention that works under all conditions, most interventions may yield modest to moderate improvements in some settings. [5] Interventions with several components (multi-faceted) seem to have a higher chance of improving practices as more barriers can be addressed and overcome with different components. [6]
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