Project Design
Design
SEA-ORCHID was a before-after study, using action research to design, tailor and implement a capacity development intervention which included skills development (training and support), network building (training fellowships and project meetings), mentoring (between-country exchanges) and resourcing (subscription to evidence based materials, travel to project meetings and relevant conferences, IT infrastructure and support).
The project comprised five phases over five years. It was conducted across seven centres; four in SE Asian and three in Australia. SE Asian study nodes were based within existing obstetric or paediatric departments and formed both the study co-ordination centre and the focus for evidence-based practice activities within the region.
Data collection
Baseline data were collected at each SE Asian node during 2005. Three categories of information were collected at baseline and again after the intervention:
1. recommended practices and health outcomes (primary outcome)
2. involvement in evidence based practice (secondary outcomes)
3. local barriers to practice change
Primary outcomes
The primary outcomes were 20 areas of current practice measuring 10 health outcomes of mothers and babies. We assessed whether current management of specific pregnancy and childbirth related issues followed best practice recommendations, and what the impact of some these practices were on the health of mothers and babies.
The examples of evidence-based practice and their associated intended health outcomes were selected on the basis of clear evidence from Cochrane reviews. The primary outcomes were collected from the case reports of women under the care of the nine hospitals associated with the four SE Asian centres.
Field workers reviewed on a prospective basis the case reports of at least 1000 women admitted over a 3 to 12 month period using customised data collection forms.
Secondary outcomes
We assessed involvement in evidence-based practice activity by charting changes between pre- and post-intervention in the following areas:
1. number of research projects related to pregnancy and childbirth
2. number of relevant local clinical practice guidelines
3. amount of undergraduate medical teaching related to evidence- based practice
4. global contribution of SE Asians to The Cochrane Collaboration
We assessed potential barriers to, and facilitators of, practice change 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 were 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 were explored, and any relevant issues were used to modify the intervention.
Data management and analysis
A customised database was housed on the project website to allow field workers to enter the data directly into the database. Data were analysed with descriptive statistics to provide a picture of current practices and outcomes in the management of pregnancy and childbirth.
Intervention
The intervention involved the following activities:
1. Training
Focused 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
Support for undertaking Cochrane reviews for interventions that were clinically relevant, culturally acceptable and feasible for the management of pregnancy and childbirth related disorders.
3. Guideline development
Support for undertaking locally relevant evidence-based guideline development and implementation based on findings of relevant systematic reviews.
4. Infrastructure support
Establishment of nodes, for example with administrative assistance and adequate access to the internet and information resources, provided a core focus for research activity and skills training.
5. Academic exchange
Over 20 short-term (1-3 months) fellowships for SE Asians to come to Australia; three study tours by Australian trainers to all SE Asian centres to conduct workshops and mentor SE Asian trainers.
6. Promotion
Four project meetings were timed to coincide with local clinical meetings and events. Work resulting from the project was published in journals and presented at international perinatal meetings and Cochrane Colloquia.
7. Input into the undergraduate curriculum
Facilitated 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.
Related publications
SEA-ORCHID study protocol
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, 7:43.
SEA-ORCHID methods and design
McDonald S, Turner T, Chamberlain C, Lumbiganon P, Thinkhamrop J, Festin MR, Ho JJ, Mohammad H, Henderson-Smart DJ, Short J, Crowther CA, Martis R, Green S for the SEA-ORCHID Study Group. Building capacity for evidence generation, synthesis and implementation to improve the care of mothers and babies in South East Asia: methods and design of the SEA-ORCHID Project using a logical framework approach. BMC Medical Research Methodology 2010, 10:61.
SEA-ORCHID baseline data for clinical practices
The SEA-ORCHID Study Group. Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries Project. PLoS ONE 2008, 3(7): e2646.
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