title: Evidence-based stillbirth prevention strategies: combining empirical and theoretical paradigms to inform health planning and decision-making.
abstract: BACKGROUND
  A global health project undertaken in Qatar on the Arabian Peninsula immersed undergraduate nursing students in hands-on learning to address the question: What strategies are effective in preventing stillbirth? Worldwide stillbirth estimates of 2.6 million per year and the high rate in the Eastern Mediterranean Region of 27 per 1,000 total live births provided the stimulus for this inquiry.
  
  
  METHODS
  We used a dual empirical and theoretical approach that combined the principles of evidence-based practice and population health planning. Students were assisted to translate pre-appraised literature based on the 6S hierarchical pyramid of evidence. The PRECEDE-PROCEED (P-P) model served as an organizing template to assemble data extracted from the appraisal of 21 systematic literature reviews ± meta-analyses, 2 synopses of synthesized reports, and 9 individual studies summarizing stillbirth prevention strategies in low, middle, and high income countries. Consistent with elements of the P-P model, stillbirth prevention strategies were classified as social, epidemiological, educational, ecological, administrative, or policy.
  
  
  RESULTS
  Ten recommendations with clear evidence of effectiveness in preventing stillbirth in low, middle, or high income countries were identified. Several other promising interventions were identified with weak, uncertain, or inconclusive evidence. These require further rigorous testing.
  
  
  CONCLUSIONS
  Two complementary paradigms--evidence-based practice and an ecological population health program planning model--helped baccalaureate nursing students transfer research evidence into useable knowledge for practice. They learned the importance of comprehensive assessments and evidence-informed interventions. The multidimensional elements of the P-P model sensitized students to the complex interrelated factors influencing stillbirth and its prevention.
authors.affiliation: Assistant Professor, University of Calgary-Qatar, Doha, Qatar.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: King
authors.forename: Amna
authors.initials: A
authors.lastname: Aden
authors.forename: Stephany
authors.initials: S
authors.lastname: Tapa
authors.forename: Reem
authors.initials: R
authors.lastname: Jumah
authors.forename: Salma
authors.initials: S
authors.lastname: Khan
mesh_terms: D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D014943:Global Health; D006285:Health Planning / Q000379:methods*; D006801:Humans; D008962:Models, Theoretical; D009773:Obstetric Nursing / Q000379:methods*; D011203:Poverty; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011314:Preventive Health Services / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*
keywords: 6S hierarchy of evidence; global health; precede-proceed model; stillbirth prevention