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

El-Khoury M, Thornton R, Chatterji M, Choi SK - BMC Health Serv Res (2015)

Bottom Line: The study fails to detect an impact on providers' knowledge of DMPA's side effects or on reported clinical practices.Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions.AEA RCT Registry, AEARCTR0000539 , 11/3/2014.

View Article: PubMed Central - PubMed

Affiliation: International Health Division, Abt Associates Inc, Bethesda, MD, USA. Marianne_ElKhoury@abtassoc.com.

ABSTRACT

Background: 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.

Methods: We 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.

Results: There 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.

Conclusions: We 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 registration: AEA RCT Registry, AEARCTR0000539 , 11/3/2014.

No MeSH data available.


Impact of EBM program on provider outcomes. The black squares denote the Intent-To-Treat coefficients without the baseline covariates; The error bars denote the 90 % confidence level; Robust standard errors; For all scores, the control group mean is zero and the standard deviation is one; The Y-axis is measured in terms of standard deviations of the outcome variable in the control group. N = 229 providers
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Fig1: Impact of EBM program on provider outcomes. The black squares denote the Intent-To-Treat coefficients without the baseline covariates; The error bars denote the 90 % confidence level; Robust standard errors; For all scores, the control group mean is zero and the standard deviation is one; The Y-axis is measured in terms of standard deviations of the outcome variable in the control group. N = 229 providers

Mentions: Figure 1 illustrates the results from separate regressions of the ITT impact estimates of the EBM program, excluding baseline covariates. The black squares represent the value of the coefficient on the treatment indicator for each outcome variable. A positive coefficient indicates that the program had a positive effect on outcomes of interest, such as knowledge about DMPA or attitudes towards the method. The figure also shows the 90 % confidence intervals for each estimated coefficient. When the confidence interval contains the value “0.00,” we are unable to reject the hypothesis that there was no significant difference between the treatment and control.Fig. 1


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

El-Khoury M, Thornton R, Chatterji M, Choi SK - BMC Health Serv Res (2015)

Impact of EBM program on provider outcomes. The black squares denote the Intent-To-Treat coefficients without the baseline covariates; The error bars denote the 90 % confidence level; Robust standard errors; For all scores, the control group mean is zero and the standard deviation is one; The Y-axis is measured in terms of standard deviations of the outcome variable in the control group. N = 229 providers
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4592549&req=5

Fig1: Impact of EBM program on provider outcomes. The black squares denote the Intent-To-Treat coefficients without the baseline covariates; The error bars denote the 90 % confidence level; Robust standard errors; For all scores, the control group mean is zero and the standard deviation is one; The Y-axis is measured in terms of standard deviations of the outcome variable in the control group. N = 229 providers
Mentions: Figure 1 illustrates the results from separate regressions of the ITT impact estimates of the EBM program, excluding baseline covariates. The black squares represent the value of the coefficient on the treatment indicator for each outcome variable. A positive coefficient indicates that the program had a positive effect on outcomes of interest, such as knowledge about DMPA or attitudes towards the method. The figure also shows the 90 % confidence intervals for each estimated coefficient. When the confidence interval contains the value “0.00,” we are unable to reject the hypothesis that there was no significant difference between the treatment and control.Fig. 1

Bottom Line: The study fails to detect an impact on providers' knowledge of DMPA's side effects or on reported clinical practices.Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions.AEA RCT Registry, AEARCTR0000539 , 11/3/2014.

View Article: PubMed Central - PubMed

Affiliation: International Health Division, Abt Associates Inc, Bethesda, MD, USA. Marianne_ElKhoury@abtassoc.com.

ABSTRACT

Background: 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.

Methods: We 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.

Results: There 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.

Conclusions: We 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 registration: AEA RCT Registry, AEARCTR0000539 , 11/3/2014.

No MeSH data available.