Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico.
BACKGROUND
It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements.


METHODS
A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables.


RESULTS
Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work.


CONCLUSIONS
This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.
Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada. steven.hoffman@uottawa.ca.|Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. steven.hoffman@uottawa.ca.|McMaster Health Forum, McMaster University, Hamilton, ON, Canada. steven.hoffman@uottawa.ca.|Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. steven.hoffman@uottawa.ca.
Steven J
SJ
Hoffman
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.|Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada.
G Emmanuel
GE
Guindon
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.|McMaster Health Forum, McMaster University, Hamilton, ON, Canada.|Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.|Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada.
John N
JN
Lavis
Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada.|McMaster Health Forum, McMaster University, Hamilton, ON, Canada.
Harkanwal
H
Randhawa
Pan American Health Organization, Washington, DC, USA.
Francisco
F
Becerra-Posada
Foreign Affairs Committee and Women's Caucus, Laos National Assembly, Vientiane, Lao PDR.
Boungnong
B
Boupha
Democratic Party of Peasants & Workers in China, Beijing, China.
Guang
G
Shi
Department of Health Policy & Management, Kazakh National Medical University, Almaty, Kazakhstan.|Evidence-Based Health Centre, Almaty, Kazakhstan.
Botagoz S
BS
Turdaliyeva
D002681:China; D055317:Evidence-Based Practice; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000523:psychology*; D006801:Humans; D007434:Intrauterine Devices; D007623:Kazakhstan; D007812:Laos; D016015:Logistic Models; D008297:Male; D008800:Mexico; D017410:Practice Guidelines as Topic
Family planning; Global health; Health human resources; Health professionals; Health systems; Intrauterine device; Knowledge translation; Medical education; Systematic reviews