Skip to main content

Table 3 Characteristics of the included reviews for human resources-training

From: Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

Reviews (n=18)

Description of included interventions

Type of studies included (no)

Targeted health care providers

Outcome reported

Pooled data (Y/N)



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


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)




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




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:



6% (1.8-15.9)




Only educational meeting vs. no intervention:




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.


NRCT: 08

CBA: 07

Doctors, midwives, managers and researchers




0.10 (0.06-0.14)




14/16 comparisons showed positive effect




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


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)




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


Healthcare professionals, residents, fellows, and other pre licensurehealthcare professional

Adoption of shared decision making:




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


Process outcomes



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


Cohort: 01

Medical students, residents

Undergraduate knowledge



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




5.6% (3.0-9.0%)




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


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




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



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:


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)




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)




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





Patients health




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




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




Worral 1997[66]

Interventions to improve medical practice like dissemination strategies such as conferences or mailing

13 trials

Physicians in HIC

Conditions studies



5/13 studies showed statistically significant results