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.
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 language | English |
|---|---|
| Pages (from-to) | 19-28 |
| Number of pages | 10 |
| Journal | International Journal of Gynecology & Obstetrics |
| Volume | 136 |
| Issue number | 1 |
| Early online date | 24 Oct 2016 |
| DOIs | |
| Publication status | Published - Jan 2017 |
Bibliographical 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.Keywords
- delivery of health care
- evidence-based medicine
- implementation research
- low-income countries
- maternal health services
- maternal mortality
- pregnancy
- systematic review
Access to Document
- Accepted Manuscript
This is the accepted version of the following article: FULL CITE, which has been published in final form at DOI: 10.1002/ijgo.12005. This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving Policy [http://olabout.wiley.com/WileyCDA/Section/id-828039.html].