Table 2 KTE with individuals, families and communities
From: Preterm birth: the role of knowledge transfer and exchange
Key barriers [14]: | |||
 • Health education materials that do not address real situation, context, problems | |||
 • Information provided passively, just for the sake of providing it, without active patient engagement | |||
 • Insensitive attitude and behaviour of providers, power imbalance, lack of respect | |||
 • Lack of translated materials and lack of qualified interpreters | |||
 • Language and reading level (particularly for migrant populations and those with low literacy) | |||
 • Low frequency of contact with provider | |||
Key facilitators [14]: | |||
 • Care and support from family members, trained doulas and other kinds of care-giving beyond doctors and nurses | |||
 • Continuous/frequent communication and exchange of information between healthcare providers and mothers rather than one-off contact or passive flow from provider | |||
 • Group antenatal care, rather than one-to-one care | |||
 • Continuity of care (particularly for maternal and newborn healthcare) | |||
 • Integrated and comprehensive care (integrated care pathway model) | |||
Message | KTE strategy | Linking RTA approach | Outcomes |
Decision aids (variety of approaches including leaflets, computer programmes, structured counselling, etc.) | Push or exchange (depending on modality) | Improved knowledge and accuracy in risk perception, improved active and informed decision-making. Reduced anxiety and improved ability to actually make decisions. No significant difference in birth outcomes (assessed in two small trials) in the context of decision aids related to breech presentation and to pain relief in labour. | |
Greatest benefits were observed when a decision support technique was implemented in the form of counselling from a care provider involving information, discussion of options and clarification of values. | |||
Healthy pregnancy [34] | Let pregnant women carry own case notes | User pull | Improved knowledge about own pregnancy and health. |
Appropriate newborn care [30] | Regular discussions throughout pregnancy between providers and pregnant mothers | Exchange | Increased early initiation of breastfeeding. |
Prevent child illness [33] | Information campaigns | Push | Improved immunisation uptake. |
Prevent child illness [33] | Evidence-based community discussions | Exchange | Improved immunisation uptake. |
Healthy pregnancy; appropriate newborn care [26,27,28,29, 31] | Community-based strategies to deliver information (e.g. use of community health workers, family-community service delivery, women’s groups) | Exchange | Depending on modality: Better prepared for birth; increased demand for information; increased use of antenatal clinics and delivery care; increased awareness about newborn care; decreased infant mortality; improved care-seeking for sick infants. |
Improve knowledge, behaviour change (many topics) [3] | Interactive computer-based health communication applications | User pull | Improved knowledge, social support, clinical outcomes. Data were insufficient for meta-analysis of biological outcomes or analysis of cost effectiveness. Effects on these outcome categories remain unknown. |
Understand risk, go for screening tests (many health topics) [3] | Personalised risk communication (written, spoken or visual) | Push | Uptake of screening tests. Low quality evidence, small effect size. |
Improve engagement with patients (many topics) [3] | Communication before consultations (i.e. patient appointments with healthcare provider) | Exchange | Increased question-asking during consultations; increased patient participation in consultation; improved patient satisfaction. Both coaching and written material interventions produced similar effects on question asking, but coaching produced a larger increase in patient satisfaction. Overall, the benefits of ‘communication before consultations’ interventions were minor. |