Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery.
The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of "opinion leadership". All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.
Center for Health Services Research in Primary Care, University of California, Davis, 4150 V. Street Suite 2500, Sacramento, CA 95817, USA. rlkravitz@ucdavis.edu
Richard L
RL
Kravitz
David
D
Krackhardt
Joy
J
Melnikow
Carol E
CE
Franz
William M
WM
Gilbert
Andra
A
Zach
Debora A
DA
Paterniti
Patrick S
PS
Romano
D000328:Adult; D001291:Attitude of Health Personnel; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data; D003657:Decision Making; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives; D009774:Obstetrics / Q000706:statistics & numerical data; D009775:Obstetrics and Gynecology Department, Hospital; D011247:Pregnancy; D011364:Professional Practice / Q000706:statistics & numerical data; D012962:Sociology, Medical; D012963:Sociometric Techniques; D013220:State Health Planning and Development Agencies; D014481:United States; D000078329:Workforce