Effectiveness of evidence-based medicine on knowledge, attitudes, and practices of family planning providers: a randomized experiment in Jordan

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.

Demand for family planning satisfied with modern methods and its associated factors among married women of reproductive age in rural Jordan: A cross-sectional study

“…Counselling at private clinics was not associated with mDFPS, even though the exposure rate was higher (42.7%) than that of health centres (28.1%) ( Table 5). Earlier studies in Jordan reported that women, especially those in urban areas, depended highly on private clinics for modern contraception [27,39,40]. Campbell et al [33] determined a close correlation between travel time to a health facility and women's use of contraceptives.…”

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“…The assessment findings suggest that both public- and private-sector providers have misconceptions about hormonal methods and side effects, despite repeated USAID investment in training initiatives. 27 – 29 One initiative included the evidence-based medicine program, a 3-month education and training program for providers on injection counseling, conducted by the SHOPS project. A 2014 randomized study showed that evidence-based medicine training provided to private-sector physicians improved their attitudes and confidence in providing injectables, but did not improve knowledge of the method or counseling practice scores.…”

“…A 2014 randomized study showed that evidence-based medicine training provided to private-sector physicians improved their attitudes and confidence in providing injectables, but did not improve knowledge of the method or counseling practice scores. 27 …”

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