Table 3.
Characteristics of the included reviews for human resources-training
| Reviews (n=18) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
|---|---|---|---|---|---|---|---|
| Other outcomes | MNCH specific outcomes | ||||||
| Bhutta 2010 [51] | In-service training to health personnel only, defined as SBAs (nurses, midwives, doctors or health personnel with midwifery skills) for better maternal outcomes. | Before after:08, Quais:02, Cross-sectional: 2 | Skilled birth attendants (doctors, nurses and midwives) as well as to other service providers (lab tech) in LMIC | Cesarean section | No | 1.78 (0.34-9.32) | |
| Maternal mortality | 0.57 (0.36-0.91) | ||||||
| Obstetric complications | 1.72 (0.72-4.10) | ||||||
| Institutional delivery | 2.92 (2.09-4.06) | ||||||
| Referrals | 0.57 (0.25-1.31) | ||||||
| Mean antenatal visits | 0.90 (0.47-1.33) | ||||||
| Giguere 2012 [72] | The distribution of published or printed recommendations for clinical care and evidence to inform practice, including clinical practice guidelines, journals and monographs. | 14 RCTs 31 ITS |
All health care professionals | PEM vs. no intervention | Yes | ||
| Practice outcomes: (categorical) | Median absolute risk difference 0.02 (range 0, 0.11) i.e. 2% absolute improvement | ||||||
| Profession practice outcomes: (continuous) | median improvement in standardised mean difference 0.13 (range -0.16, 0.36) | ||||||
| Forsetlund 2009 [53] | We included the following types of educational meetings: conferences, lectures, workshops, seminars, symposia, and courses. | Trials: 81 | Qualified health professionals or health professionals in postgraduate training mostly in HIC | Any intervention with educational meeting vs. no intervention: | Yes | 6% (1.8-15.9) | |
| Compliance | |||||||
| Only educational meeting vs. no intervention: | |||||||
| Compliance | 6% (2.9-15.3) | ||||||
| Achievement of treatment goal | 3 (0.1-4) | ||||||
| Hulscher 2005 [54] | Within the professional oriented interventions we distinguished between conceptually different interventions: information transfer, learning through social influence, feedback and reminders. | RCT: 37 Quasi: 18 |
Family physicians, general internists, gynaecologists, obstetricians, pediatricians and sometimesother professionals like nurse practitioners and radiologists in HIC | Preventive services: | |||
| Group education vs. no intervention | Range: -4% - 31% | ||||||
| Multifaceted interventions versus group education | Range: -31% - 28% | ||||||
| Hyde 2000 [55] | Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual’s work. | RCT:01 NRCT: 08 CBA: 07 |
Doctors, midwives, managers and researchers | Knowledge | Yes | 0.10 (0.06-0.14) | |
| Skills | 14/16 comparisons showed positive effect | ||||||
| Attitude | 4/4 comparisons showed positive impact | ||||||
| Lassi 2010 [39] | Intervention packages that included additional training of outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care. | 18 cluster-randomized/quasi-randomized trials | Outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in LMIC | Maternal mortality | Yes | 0.77 (0.59-1.02) | |
| Maternal morbidity | 0.75 (0.61-0.92) | ||||||
| Neonatal mortality | 0.76 (0.68-0.84) | ||||||
| Perinatal mortality | 0.80 (0.71-0.91) | ||||||
| Referral | 1.4 (1.19-1.65) | ||||||
| Early breast feeding | 1.94 (1.56-2.42) | ||||||
| Légaré 2010 [56] | Interventions may include but are not limited to the distribution of printed educational material, educational meetings, audit and feedback, reminders, and patient-mediated interventions | RCT’s:05 | Healthcare professionals, residents, fellows, and other pre licensurehealthcare professional | Adoption of shared decision making: | No | ||
| Both patient mediated interventions | 1.06 (0.62-1.5) | ||||||
| Multifaceted intervention vs usual care | 2.11 (1.3-2.9) | ||||||
| Lugtenberg 2008 [57] | CPGs were defined as ‘‘systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances.’’ | cRCT: 10, before after: 10, ITS: 1 | Physicians | Process outcomes | No | 17/19 studies showed significant improvements | |
| Patient outcomes | 6/9 studies showed significant but small improvements | ||||||
| Norman 1998 [58] | The conscientious explicit and judicious use of current evidence in making decisions about the care of individual patients | RCT: 03 CT:06 Cohort: 01 |
Medical students, residents | Undergraduate knowledge | No | Mean gain 17.0%; [SD] 4.0%). | |
| Residents knowledge | Mean gain 1.3%; SD 1.7%). | ||||||
| O’Brien 2007 [59] | Educational outreach visits, defined as use of a trained person from outside the practice setting who meets with healthcare professionals in their practice settings to provide information with the intent of changing their performance. | RCT: 69 | Healthcare professionals | Compliance | Yes | 5.6% (3.0-9.0%) | |
| Prescribing | 4.8% (3.0-6.5%) | ||||||
| Professional Performance | 6.0% (3.6-(16.0) | ||||||
| Opiyo 2010 [60] | Following in-service training courses aimed at changing provider behavior in the care of the seriously ill newborn or child: Neonatal and pediatric life support courses e.g. NLS, NRP, PALS, PLS, and others. Life support elements. Other in-service newborn and child health training courses aimed at the recognition and management of the seriously ill child | RCT: 02 | Doctors (general practitioners and specialists), nurses, pharmacists and dieticians/nutritionists, in outpatient or hospital-based settings in LMIC | Performance of adequate initial resuscitation steps | No | 2.45 (1.75-3.42) | |
| Frequency of inappropriate and potentially harmful practices | 0.40 (0.13-0.66) | ||||||
| Oxman 1995 [61] | Participation of health care providers in conferences, lectures, workshops or traineeships outside their practice settings. | Trials: 17 | General healthcare providers | Change in health outcome and performance | No | Narrative | |
| Reeves 2008 [62] | An IPE intervention occurs when members of more than one health and/or social care profession learn interactively together, for the explicit purpose of improving inter-professional collaboration and/or the health/well being of patients/clients. | RCT: 04 CBA: 02 |
Health and social care professionals | Patient satisfaction | No | 4/6 reported positive outcomes | |
| Collaborative team behavior | |||||||
| Reduction in clinical error | |||||||
| Sibley 2012 [73] | Trained birth attendants training | RCT: 6 | Trained birth attendants | Trained birth attendants versus untrained birth attendants: | No | Adjusted OR (95% CI) | |
| Still births | 0.69 (0.57 to 0.83) | ||||||
| Perinatal death | 0.70 (0.59 to 0.83) | ||||||
| Maternal mortality | 0.74 (0.45 to 1.22) | ||||||
| Referral | 1.50 (1.18 to 1.90) | ||||||
| Neonatal deaths | 0.71 (0.61 to 0.82) | ||||||
| Obstructed labor | 1.26 (1.03 to 1.54) | ||||||
| Hemorrhage | 0.61 (0.47 to 0.79) | ||||||
| Puerperal Sepsis | 0.17 (0.13 to 0.23) | ||||||
| Smits 2002 [63] | Educational intervention was problem based learning | RCT’s: 06 | Post graduate continuing education in HIC | Participant’s knowledge, performance, satisfaction | No | Narrative | |
| Patients health | |||||||
| Follow-up | |||||||
| Thomas 1999 [64] | Effect of clinical guideline on behavior of nurses, midwives or PAM's, on patient outcomes | RCT: 13 CBA: 2 ITS: 03 |
Nursing, midwifery, health visiting, podiatry, speech and language therapy, physiotherapy and occupational therapy, pharmacy and radiography | General effectiveness | No | Narrative | |
| Wensing 1998 [65] | Information transfer through group education, reading material and patient education | RCT: 39 CBA: 22 |
Physicians in HIC | Effectiveness against the reported outcome measures | No | Narrative | |
| Worral 1997 [66] | Interventions to improve medical practice like dissemination strategies such as conferences or mailing | 13 trials | Physicians in HIC | Conditions studies | No | 5/13 studies showed statistically significant results | |