Effectiveness of health education in reducing secondhand smoke exposure among pregnant women visiting the antenatal clinic in Saudi Arabia: A randomized controlled trial.

BACKGROUND: Pregnant women's exposure to secondhand smoking (SHS) is associated with detrimental effects on the pregnancy outcomes. OBJECTIVES: The objective of the study was to compare the effectiveness of face-to-face counseling, based on health belief model (HBM), combined with a written educational pamphlet, and health education using written pamphlet only, in improving pregnant women's perception, behavior to avoid SHS and change in exposure to SHS. METHODS: A randomized controlled trial was conducted in 2016. The intervention group received face-to-face health counseling on SHS, while the control group received only written educational pamphlets. Outcomes were the change in the perception of mother on the four constructs of the HBM and the change in mothers' behavior of avoidance of SHS exposure. RESULTS: A total of 100 women were recruited for the study, of whom 93 (47 intervention and 46 control) women completed the study. All women identified their spouse as a source of SHS exposure. Following the intervention, the intervention group had significantly higher scores in the perception of susceptibility (21 ± 4 vs. 16 ± 7, P < 0.01) and severity (15 ± 3 vs. 12 ± 4, P < 0.01) and reduced perception scores of barriers to avoid SHS exposure (11 ± 4 vs. 9 ± 5, P = 0.03), compared to the control group. However, there was an insignificant change in the exposure to SHS after the intervention in both the groups; where 25 (53.2%) women in the intervention group and 31 (67.4%) in the control group (P = 0.16), continued to being exposed to SHS. CONCLUSION: Counselling of pregnant women, based on HBM, has insignificant effect in reducing their exposure to SHS; however it is effective in improving their knowledge and perception about SHS exposure.

Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region.

RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS: Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS: In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION: This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.

Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East.

RATIONALE, AIMS, AND OBJECTIVES: Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. METHODS: This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. RESULTS: The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. CONCLUSION: In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions.