Evaluation of two strategies for the transfer of research results about labour support and electronic fetal monitoring into practice

grantor: University of TorontoEvidence-based recommendations published in 1995 by the Society of Obstetricians and Gynaecologists of Canada included increasing the provision of professional support to women in labour and decreasing the use of electronic fetal monitoring for low-risk pregnancies. An intervention to facilitate the transfer of these recommendations into practice based on Social Cognitive Theory (Bandura, 1986) and the Coordinated Implementation Model (Lomas, 1993) was evaluated at four hospitals. Two control hospitals received the standard regional approach to dissemination, with a multi-agency committee, newsletter articles and multi-disciplinary conferences. Two experimental hospitals received this approach plus additional activities tailored to the hospital which included policy meetings, written information, workshops attended by >80% of the nurses, multi-disciplinary rounds and follow-up discussions. A pre (fall 1995) and post (fall 1996) design was used. One hospital of each type (secondary/tertiary) was randomly allocated to receive the tailored intervention. Chi-square tests were used to compare differences over time within each hospital to determine if there was an increase in labour support (LS) or a decrease in any electronic fetal monitoring (EFM). The participation rate of nurses was >=98%. At the experimental hospitals, there were improvements in two outcomes: an increase in LS at the tertiary hospital (+6.3%, 'p' = .0002); and a large decrease in EFM at the secondary hospital (-49.1%, 'p' < .0001). At the control hospitals, there was a small improvement in one outcome, a decrease in EFM at the tertiary hospital (-8.1%, 'p' = .0001), and a negative effect in the other outcome, a decrease in LS at the secondary hospital (-6.8%, 'p' = .0001). A hospital-tailored intervention for the transfer of research had some beneficial effects on practice. No association was found between the reduction in the use of EFM and an increase in the proportion of time that the average nurse provided LS. No differences in neonatal outcomes were found at the hospital with a major decrease in the use of EFM technology. Future research is recommended on group behaviour change mechanisms, "report cards" for hospitals and the public about interventions and outcomes, and the involvement of administrators in designing research transfer strategies.Ph.D