Download full project protocol, as published in BMC Medical Research Methodology, 2007.
[Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, Green S, Crowther CA. Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol. BMC Medical Research Methodology 2007, 7:43doi:10.1186/1471-2288-7-43.]
The project is an interrupted time series, which will both extend and benefit from existing networks. The project comprises five phases over five years:
4. outcome assessment
5. reporting / dissemination
The project will be conducted across seven centres; four in SE Asian and three in Australia . At each SE Asian centre a study node will be established. These will be based within existing obstetric and paediatric departments and form both the study co-ordination centre and the focus for evidence-based practice activities within the region.
Activities and timelines for each project phase - View timelines
Pre-intervention phase (2005)
During this phase, baseline data collection will be conducted within each SE Asian node and staff to deliver the intervention will be recruited and trained. Three categories of information will be gathered at baseline and again after the intervention, relating to:
1) recommended practices and health outcomes (primary outcome)
2) current involvement in evidence based practice
3) potential local barriers to practice change
Twenty areas of current practice measuring ten health outcomes of mothers and babies will be the primary outcomes. We will assess whether current management of specific pregnancy and childbirth related issues follows best practice recommendations, and what the impact of some these practices are on the health of mothers and babies.
Health related outcomes - View outcomes
The examples of evidence-based practice and their associated intended health outcomes have been selected on the basis of clear evidence from Cochrane systematic reviews. The primary outcomes will be collected from the case reports of women under the care of the hospitals associated with the nodes.
Field workers in each node will review on a prospective basis consecutive case reports of at least 1000 women admitted over a nine-month period using customised data collection forms.
1. Current levels of evidence-based activity
We will assess current levels of activity by identifying:
- number of research projects related to pregnancy and childbirth practices
- number of relevant local clinical practice guidelines
- amount of undergraduate medical course teaching related to evidence-based practice
- global contribution of SE Asians to the Cochrane Collaboration
2. Potential local barriers to and facilitators of practice change
We will assess potential barriers by carrying out a series of qualitative assessments and focus groups within the participating institutions to establish the current issues and organisational factors specific to that node which may form a barrier to practice change, or may be recruited to enhance practice change.
The current knowledge and beliefs about evidence-based practice, research results and systematic reviews will be assessed, along with perceived difficulties in accessing, appraising and using research-based information. Culturally specific barriers to use of the selected pregnancy and childbirth practices will be explored, and any relevant issues will be used to modify the intervention.
Data management and analysis
A customised database will be housed on the project web site to allow field workers to enter the information on data collection forms directly into the database. Baseline data will be analysed with descriptive statistics to provide a picture of current practices and outcomes in the management of pregnancy and childbirth in the four nodes.
Intervention phase (2006-mid 2007)
The intervention will involve the following activities:
1. Training: in collaboration with the SE Asian nodes, training activities will focus around three core groups: generators of evidence and evidence-based materials (systematic reviewers and guideline developers); users of evidence (clinicians and policy makers); educators about evidence (teachers and trainers).
2. Systematic reviewing: complete systematic reviews for interventions that are clinically relevant, culturally acceptable and feasible for the management of pregnancy and childbirth related disorders.
3. Guideline development: co-ordinate and facilitate locally relevant evidence-based guideline development and implementation based on findings of relevant systematic reviews.
4. Infrastructure support: establishment of nodes will provide a core focus for research activity and skills training.
5. Academic exchange: four six-month fellowships for SE Asians to come to Australia and three study tours by Australian trainers to all the nodes to conduct workshops and mentor SE Asian trainers.
6. Promotion: four project conferences will be timed to coincide with local clinical meetings and events. Work resulting from the project will be published in journals and presented at international perinatal meetings and Cochrane Colloquia.
7. Input into the undergraduate curriculum: facilitate teaching of EBP skills in medical, nursing and allied health schools by sharing knowledge, skills and materials from Australia together with content relevant to SE Asia.