Cluster Randomized Trial of an Active, Multifaceted Educational Intervention Based on the WHO Reproductive Health Library to Improve Obstetric Practices
Bibliographic record
Abstract
The hypothesis underlying this study was that hospital obstetrical practices can be improved by interactive workshops that promote the use of evidence-based measures based on the World Health Organization’s Reproductive Health Library (RHL). The RHL is an annually updated electronic publication featuring Cochrane reviews in the area of reproductive health along with expert commentary, practical guidance documents, and various aids such as educational videos. Participating in the trial were 22 hospitals in Mexico City and 18 in northeast Thailand, whose maternity units conducted more than a thousand deliveries each year, and which had no direct affiliation with a university or other academic or research facility. Three workshops were held during a 6-month period: the first provided information about the project and principles of evidence-based decision-making; the second focused on RHL content; and the third concerned how best to implement desired changes. A stratified cluster randomized design took country, type of hospital, and number of births per year into account. The chief outcome measures were changes in 10 clinical practices as recommended in the RHL, implemented within 4 to 6 months after the third workshop. The intervention failed to influence targeted practices in any consistent or substantive way. Three of the 10 practices (iron/folate supplementation, postnatal uterotonic use, breast feeding on demand) already were part of the practice regimen, and it proved impractical to measure external cephalic version. Selective rather than routine episiotomy was performed more often in the intervention hospitals than in control hospitals. In Mexico, antibiotics tended to be used more at the time of cesarean delivery. No significant differences were documented in companionship during labor, the use of magnesium sulfate to treat eclampsia, corticosteroid treatment of women delivering before 34 weeks’ gestation, or the use of vacuum extraction. Awareness of the RHL increased substantially following the intervention at both study sites, as did its use. Despite the efficacy of active educational measures in expanding access to the RHL and promoting its use, this study failed to demonstrate lasting or substantial changes in reproductive medical practices. Within a 10- to 12-month time frame, at least, access to current knowledge of such practices apparently does not assure that they will become part of standard obstetrical care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.004 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".