title: Diffusion of innovation: enhancing the dissemination of the Ponseti method in Latin America through virtual forums.
abstract: This ethnographic study evaluated the use of low-bandwidth web-conferencing to enhance diffusion of a specific best practice, the Ponseti method to treat clubfoot, in three economically diverse countries in Latin America. A "Ponseti Virtual Forum" (PVF) was organized in Guatemala, Peru and Chile to examine the influences of economic level and telecommunication infrastructure on the effectiveness of tins approach. Across the three countries, a total of 14 different sites participated in the PVFs. Thirty-three Ponseti-trained practitioners were interviewed before and after each PVF, which included interactions with a Spanish-speaking Ponseti method expert. Semi-structured interviews, observations, and IP address data were triangulated and analyzed. The results demonstrated that 100% of the practitioners rated the sessions as very useful and that they would use this approach again. The largest obstacles to using PVFs were financial (7 out of 9 practitioners) in Guatemala; a lack of equipment and network access (6 out of 11) in Peru; and the organization and implementation of the conferences themselves (7 out of 9) in Chile. This study illustrates the usefulness of Ponseti Virtual Forums in Latin America. Health officials in Peru are currently developing a large-scale information session for traumatologists about the Ponseti method, while practitioners in Guatemala and Chile are organizing monthly scholarly meetings for physicians in remote areas. This initial feedback suggests that low-bandwidth web-conferencing can be an important vehicle for the dissemination of best practices, such as the Ponseti method, in developing countries.
authors.affiliation: Department of Orthopaedics and Rehabilitation Carver College of Medicine University of Iowa, Iowa City, IA 52242, USA.
authors.forename: Asitha
authors.initials: A
authors.lastname: Jayawardena
authors.forename: Allison
authors.initials: A
authors.lastname: Boardman
authors.forename: Thomas
authors.initials: T
authors.lastname: Cook
authors.forename: Florin
authors.initials: F
authors.lastname: Oprescu
authors.forename: Jose A
authors.initials: JA
authors.lastname: Morcuende
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002370:Casts, Surgical / Q000592:standards / Q000706:statistics & numerical data*; D002648:Child; D002677:Chile / Q000453:epidemiology; D003025:Clubfoot / Q000208:ethnology* / Q000628:therapy*; D003906:Developing Countries / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D026201:Musculoskeletal Manipulations / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000379:methods / Q000706:statistics & numerical data; D010568:Peru / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011639:Public Opinion; D036301:Qualitative Research
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