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Health Education Research Advance Access published online on March 29, 2007
Health Education Research, doi:10.1093/her/cym012
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

María Belizan1, Andrea Meier2, Fernando Althabe3, Agustina Codazzi3, Mercedes Colomar3, Pierre Buekens4, Jose Belizan1, Joan Walsh5 and Marci Kramish Campbell6,*

1 Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
2 School of Social Work, University of North Carolina, Chapel Hill, NC 27599, USA
3 Perinatal Research Unit, Montevideo, Uruguay
4 Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
5 Department of Maternal and Child Health, University of North Carolina, Chapel Hill, NC, USA
6 Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA

Correspondence to: * Correspondence to: M. K. Campbell. E-mail: campbel7{at}email.unc.edu.

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.


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