Pathways to evidence‐based reproductive healthcare in developing countries

Abstract

Objective Developing country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries. Design Qualitative study using semi-structured interviews.Setting India and Yemen.Sample Forty-one doctors working in obstetrics, gynaecology, general practice and family planning services.Methods Interviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis. Main outcome measures Descriptions of experiences, attitudes and needs.Results Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice. Conclusions Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.

Promoting development and use of systematic reviews in a developing country

“…First it was primarily based on the views of those at the first line of conduct and support for systematic reviews as well as those charged with the use and implementation of the best available evidence in national decision making. Second, most of previously recommended interventions focused on how to make systematic reviews conducted in developed settings more relevant to developing countries and how to increase the share of systematic reviewers from developing countries in Cochrane activities [7,8].…”

“…This cluster included items 4,7,8,14,19 and 20 (Table 1). Items 'competency of researchers in conducting systematic reviews' and 'training of professional methodologists in the systematic review related fields' received considerable support.…”

“…by conducting and reporting systematic reviews in a way that is more useful for developing countries [3]; in other words, asking investigators from resourceful countries to develop evidence in a way that is more beneficial to health systems with limited resources. Other recommendations include facilitating further access to systematic reviews (including Cochrane reviews) [7], direct support from Cochrane entities and the 'developed world' for capable investigators in developing countries so that they can generate the evidence required for decision making in developing countries [8], and facilitating registration of systematic reviews and participation of authors from developing countries [3].…”

Factors associated with the awareness and practice of evidence‐based obstetric care in an African setting

“…Previous descriptions were based on anecdotes, speculation and qualitative data. 20 Awareness was associated with a tremendous 15-fold increase in practice. Obstetric/ gynaecologic training and 5-15 years of work experience were associated with increased awareness but not with practice, while access to the internet was associated with increased practice only.…”

Evidence-based abstracts: what research summaries should contain to support evidence-based medicine

“…EBP requires access to medical resources, but whenever this is not feasible as is the case in many regions worldwide, 14,17 some other strategies should be used. One option is the use of research abstracts that are often available from free online resources, such as PubMed.…”