Pathways to evidence-based reproductive healthcare in developing countries

Objective Developing country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical. knowledge in developing countries. Design Qualitative study using semi-structured interviews. Setting India and Yemen. Sample Forty-one doctors working in obstetrics, gynaecology, general practice and family planning services. Methods Interviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis. Main outcome measures Descriptions of experiences, attitudes and needs. Results Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice. Conclusions Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.