Getting evidence into practice: what works in developing countries?
OBJECTIVE
We summarize and comment on the available literature on the effectiveness of interventions designed to change professional behaviour in order to bring evidence into practice in developing countries.


METHODS
We used a strategy adapted from the Effective Practice & Organization Care (EPOC) Cochrane group.


METHODS
Forty-four studies met pre-defined selection criteria. Controlled and uncontrolled trials of interventions were included. Studies measured either professional compliance with agreed standards or patients' clinical outcomes. Data extraction. Data were extracted using a pre-defined extraction tool and studies were appraised accordingly.


RESULTS
Data were synthesized and categorized according to different types of intervention. Audit and feedback was found to be effective, at least in the short term, when combined with other approaches. Similarly, educational interventions were more effective when designed to address local educational needs and organizational barriers. We found insufficient evidence to assess the effectiveness of educational outreach, local opinion leaders, use of mass media, and reminders. Educational materials alone are unlikely to influence change. However, the majority of studies had weak designs and failed to exclude possible biases.


CONCLUSIONS
Current evidence for the effectiveness of interventions to change health professionals' behaviour in developing countries is either scanty or flawed due to poorly designed research. Given the recent drive to improve quality of care, this should be a priority area for researchers and international agencies supporting health systems development in developing countries. This review provides an insight into some of the methodological issues that interested researchers may face.
Siddiqi
Kamran
K
Nuffield International Health and Development Centre, Institute of Health Sciences and Public Health Research, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK. hssks@leeds.ac.uk
Newell
James
J
Robinson
Mike
M
D003906:Developing Countries; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D011785:Quality Assurance, Health Care