Abstract
BackgroundProvider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan. Evidence-Based Medicine (EBM) programs aim to reduce biases and misconceptions by providing doctors with the most up-to-date scientific evidence on contraceptive methods.MethodsWe evaluate the effects of an EBM program conducted in Jordan on private providers’ knowledge, attitudes, and practices. Family planning providers randomly assigned to a treatment group were invited to attend a roundtable seminar on the injectable contraceptive Depot Medroxy Progesterone Acetate (DMPA), and to receive two 15 min one-on-one educational visits that reinforce the messages from the seminar.ResultsThere was low compliance with the EBM program. The study fails to detect an impact on providers’ knowledge of DMPA’s side effects or on reported clinical practices. There is suggestive evidence of a positive impact on providers’ attitudes toward and confidence in prescribing the contraceptive to their patients. There is also evidence of positive selection into program participation.ConclusionsWe conclude that EBM may not be effective as a stand-alone program targeting a family planning method with a high level of provider and consumer bias. Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions.Trial registrationAEA RCT Registry, AEARCTR0000539, 11/3/2014Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1101-z) contains supplementary material, which is available to authorized users.
Highlights
Provider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan
Studies in Tanzania, [2] Ghana, [3] and Bangladesh [4] have demonstrated that family planning providers sometimes deny women access to a particular contraceptive method based on their own lack of knowledge and/or biases
This paper evaluates a program in Jordan that provided private family planning doctors with scientific evidence about Depot Medroxy Progesterone Acetate (DMPA), a hormonal injectable contraceptive with low rates of use in Jordan
Summary
Provider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan. Evidence-Based Medicine (EBM) programs aim to reduce biases and misconceptions by providing doctors with the most up-to-date scientific evidence on contraceptive methods. Provider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries [1]. One approach to reduce biases and misconceptions is to provide doctors with the most up-to-date scientific evidence regarding contraceptive methods. This principle is EBM has been defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” [5]. The hypothesized theory of change underlying this approach is that EBM improves knowledge of family planning methods by providing credible documented evidence, knowledge that in turn modifies existing negative attitudes and practices among health providers
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