Local opinion leaders effects on professional practice and health care outcomes

RHL practical aspects by Althabe F

As mentioned in the commentary, this intervention is mainly applicable at health facilities in urban areas where health-care professionals function in teams. In rural settings, where health-care providers work in relative isolation, this strategy would not be easily applicable.


For the selection of opinion leaders: In my personal experience and opinion, adapting the sociometric method questionnaire developed by Hiss (1) to suit local conditions is the most appropriate method for selecting opinion leaders. It allows health-care professionals to describe which colleagues are educationally influential, knowledgeable, and humane. In a trial conducted by my colleagues and myself at 19 hospitals in large urban Latin American settings, we selected opinion leaders using the sociometric method (2). The following step-by step process could be used to select opinion leaders:

  • Distribute the Hiss questionnaire to all health-care professionals working in the setting where the intervention is to be implemented.
  • Ask each health-care professional to complete the questionnaire anonymously and return it in an opaque envelope, preferably by placing it into a sealed box specially prepared for that purpose. Ensure that health-care professional understand that the selection process will be managed confidentially. It will probably increase the response rate.
  • Make every effort to achieve a high response rate: select a respected person to distribute the questionnaire, to periodically remind the subjects to complete it, and to collect the completed questionnaires.
  • The best opinion leaders will (theoretically) be those health-care professionals who receive the most votes.
  • Inform all health-care professionals (including the elected opinion leaders) of the results.
  • Invite the elected professionals to work as opinion leaders.

It should be mentioned that there is no evidence that this method is better than the informant method (asking individuals to identify those individuals who act as principle sources of influence) (3).


This intervention would be difficult to implement in settings in which health-care providers work in relative isolation.


  • Hiss RG, MacDonald R, David WR. Identification of physician educational influentials in small community hospitals. Washington DC: Proceedings of the Seventeenth Annual Conference on Research in Medical Education; 1978:283-8.
  • Althabe F, Buekens P, Bergel E, Belizan JM, Kropp N, Wright L, et al., for the Guidelines Trial Group. A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627]. BMC Womens Health 2005;5:4.
  • Doumit G, Gattellari M, Grimshaw J, O'Brien MA. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007;Issue 1. Art. No.: CD000125; DOI: 10.1002/14651858.CD000125.pub3.

This document should be cited as: Althabe F. Local opinion leaders: effects on professional practice and health-care outcomes : RHL practical aspects (last revised: 20 August 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.