A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries

Mari Imamura, Lovney Kanguru, Suzanne Penfold, Tim Stokes, Janette Camosso-Stefinovic, Beth Shaw, Julia Hussein

Research output: Contribution to journalArticle

3 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background
Healthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge.

Objectives
To assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs).

Search strategy
Electronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. “audit,” “education,” “reminder”), and maternal mortality.

Selection criteria
Randomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included.

Data collection and analysis
Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed.

Main results
Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor–patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies.

Conclusions
Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context.
PROSPERO
CRD42014010310

Data collection and analysis: Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, narrative synthesis was completed.
Main results: Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor–patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies.
Conclusions: Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMIC. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context.
Original languageEnglish
Pages (from-to)19-28
Number of pages10
JournalInternational Journal of Gynecology & Obstetrics
Volume136
Issue number1
Early online date24 Oct 2016
DOIs
Publication statusPublished - Jan 2017

Fingerprint

Obstetrics
Guidelines
Infant Mortality
Analgesics
Emergencies
Mothers
Maternal Death
Maternal Mortality
Health
Health Services
Databases
Delivery of Health Care
Education

Keywords

  • delivery of health care
  • evidence-based medicine
  • implementation research
  • low-income countries
  • maternal health services
  • maternal mortality
  • pregnancy
  • systematic review

Cite this

A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries. / Imamura, Mari; Kanguru, Lovney; Penfold, Suzanne ; Stokes, Tim; Camosso-Stefinovic, Janette; Shaw, Beth; Hussein, Julia.

In: International Journal of Gynecology & Obstetrics, Vol. 136, No. 1, 01.2017, p. 19-28.

Research output: Contribution to journalArticle

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abstract = "BackgroundHealthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge.ObjectivesTo assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs).Search strategyElectronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. “audit,” “education,” “reminder”), and maternal mortality.Selection criteriaRandomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included.Data collection and analysisCochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed.Main resultsNine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor–patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies.ConclusionsImplementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context.PROSPEROCRD42014010310Data collection and analysis: Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, narrative synthesis was completed.Main results: Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor–patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies.Conclusions: Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMIC. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context.",
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note = "The study was funded by the John D. and Catherine T. MacArthur Foundation (grant number: 12-100074-000-INP). The views expressed here are the authors’ and do not necessarily reflect those of any other person or organization.",
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AU - Camosso-Stefinovic, Janette

AU - Shaw, Beth

AU - Hussein, Julia

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