Foreword: Maternal and childbirth health systematic reviews

Systematic reviews provide evidence about the effectiveness of many health interventions. However, translation of this evidence into routine health care is often not happening.1,2 The mere existence of evidence likely to improve patient care and health outcomes does not ensure that providers are informed and change their practices.3 Traditional strategies, such as passive dissemination of evidence via online bibliographical databases and peer-reviewed journals or distribution of educational materials, are not sufficient to change clinicians' practices.4 Implementation strategies of evidence-based guidelines show only a modest improvement of care.5,6 Studies assessing these dissemination and implementation strategies are extremely heterogeneous in their effects and methods used,5 and their number is also limited. Thus, reviews of evidence performed from these studies are inconclusive.7,8 We know ‘what works,’ but major efforts need to be made to better understand ‘how to disseminate and implement’ this knowledge into practice. Adoption of new practices by health care providers is a complex event that depends not only on access to sound evidence but also on a variety of other factors, such as the nature and cost–benefit of the interventions for the patients, the clinicians and the health care system, the clinical setting, the individual characteristics, the social context, and other organisational and institutional factors. Identification of these multi-level factors is essential to develop effective dissemination and implementation strategies. In this endeavour, behavioural and social scientists play a key role in understanding how behavioural changes in clinicians can be successfully achieved.3 Further research, using rigorous methods and randomised designs, is needed to develop appropriate and effective interventions that integrate components of behavioural change theories.5 Moving towards more evidence-based dissemination and implementation will increase the impact of evidence and ultimately help to improve health care. The success of this research depends largely on a multi-disciplinary approach to developing strong theoretical models of behavioural changes adapted to health care settings. It is time for the dissemination and implementation of evidence-based medicine to become evidence based. The United States has not been at the forefront of the evidence-based medicine movement. The US Cochrane Center is very active, and Cochrane reviews are prepared by US researchers on a regular basis. However, the lack of funding to prepare reviews is a major problem in a country in which it is expected that funding agencies pay each fraction of salary devoted to research projects. The constraints of such a billing system limit participation in volunteer organisations, such as the Cochrane Collaboration. An additional challenge is that US agencies are funding systematic reviews that follow an approach slightly different from the one used by the Cochrane Collaboration. We are very pleased that the Agency for Healthcare Research and Quality (AHRQ) funded the meeting from which this journal supplement is derived and which provided a unique opportunity for a dialogue between researchers involved in these different approaches. For many years, Latin American institutions have been promoting the dissemination and use of evidence-based practices. A leading role of this movement in the maternal and childbirth area has been performed by the Rosario Centre for Perinatal Studies and the Latin American Center for Perinatology (PAHO/WHO).9 Performance of systematic reviews by Latin American scientists in this field is the result of strong personal efforts without planned institutional or country support for their endeavours. Promotion and access of Cochrane reviews have been developed, as well as the free distribution of the WHO Reproductive Health Library, both in Spanish. The regional PAHO/WHO centre broadly promoted and trained professionals in the performance of systematic reviews and evidence-based guidelines in all 23 Latin American countries and, as a consequence, many of these countries have begun incorporating the evidence-based approach into their national guidelines. Additionally, many countries have laws enforcing the rights of pregnant women to receive evidence-based practices.10 Regardless of these advances, however, the use of evidence-based practices in maternal and childbirth care is still very low .11 This supplement of Paediatric and Perinatal Epidemiology contains peer-reviewed papers resulting from a research meeting sponsored by AHRQ, the US Department of Health and Human Services and the Tulane University School of Public Health and Tropical Medicine. The meeting, entitled Maternal and Childbirth Health Systematic Reviews, took place in New Orleans, LA, on 1–3 March 2007. The purpose of the meeting was primarily to gather experts in the field of evidence-based maternal and child health research to discuss diverse experiences and to explore challenges and innovative approaches to improve the preparation of systematic reviews and the implementation of evidence-based interventions in the Americas. During the symposia, the following specific themes were addressed: (1) performing systematic reviews on maternal and childbirth health issues, including ones relevant for less-developed countries, (2) updating existing systematic reviews, and (3) diffusing and implementing evidence into practice in the Americas. Practical recommendations were prepared during small group discussions for each theme and are reported elsewhere in this issue.12 The meeting was attended by participants from a broad range of disciplines, institutions and countries, and included representation from the Centers for Disease Control and Prevention in Atlanta, GA, USA, the Universities of York and Liverpool in the UK, the Universities of Montréal and Ottawa in Canada, the Fundación Santa Fe de Bogotá in Colombia, and the Institute for Clinical Effectiveness and Health Policy in Argentina, as well as various US universities. The articles in this issue were written by the meeting speakers and provide a variety of perspectives on the challenges and strategies to overcoming the barriers in performing, updating and implementing evidence-based interventions in the field of maternal and child health. Funding for the meeting on maternal and childbirth systematic reviews was made possible in part by R13 HS16273 from the AHRQ. The views expressed in this supplement do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organisations imply endorsement by the U.S. Government. The authors thank Andrea Meyer for assistance with this and all other articles included in this supplement of Paediatric and Perinatal Epidemiology. The authors declare no conflict of interest in this work. Frédérique A. Jacquérioz, MD, MPH, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. José M. Belizán, MD, PhD, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. Pierre Buekens, MD, PhD, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. Andrea Meyer, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. Fernando Althabe, MD, MSc, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. Eduardo Bergel, PhLic, MSc, World Health Organization, Geneva, Switzerland. Agustín Ciapponi, MD, MSc, Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. Agustín Conde-Agudelo, MD, MPH, Fundación Santa Fe de Bogotá, Bogotá, Colombia. Kay Dickersin, PhD, Johns Hopkins Center for Clinical Trials, U.S. Cochrane Center, Baltimore, MD, USA. Ann-Margret Ervin, MPH, PhD, Johns Hopkins Bloomberg School of Public Health, Cochrane Eyes and Vision Group, U.S. Project, Baltimore, MD, USA. William Fraser, MD, MSc, FRCPC, Université de Montréal, Montréal, Canada. Jeremy Grimshaw, MBChB, PhD, University of Ottawa, Ottawa, Canada. James P. Neilson, MD, University of Liverpool, Liverpool, UK. James R. Scott, MD, University of Utah Medical Center, Salt Lake City, UT, USA. Roger F. Soll, MD, University of Vermont College of Medicine, Burlington, VT, USA. Meera Viswanathan, PhD, RTI International, Research Triangle Park, NC, USA.

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