Local opinion leaders effects on professional practice and health care outcomes
RHL practical aspects by Souza JP
Best practices are evidence-based, patient-centred and cost–effective forms of care. To modify current practices of health-care providers, behavioural change is necessary. Changing the behaviour of health-care providers is known to be one of the most difficult tasks, irrespective of strengthen of evidence. Involving local opinion leaders in promoting best practices is an effective strategy for facilitating behaviour change in health-care providers.
The key element in this intervention is the identification of local opinion leaders. There are several ways of doing that. Asking health-care providers, by way of a questionnaire, to suggest whom they would trust as an opinion leader seems to be a good and relatively easy method.
After local opinion leaders are identified, it is necessary to learn how motivated they are about promoting behavioural changes among their peers. An educational meeting is usually necessary to raise awareness among the opinion leaders about the selected best practices and to persuade them to promote change. Discussing with local opinion leaders the current evidence and the current local practices can be useful to tailor the strategy for change implementation. Continued support (i.e. academic detailing) for opinion leaders can be used to keep them committed to changing the behaviour of their peers (1, 2).
However, promoting change is not easy. Several barriers must be overcome (i.e. medical traditions, old behaviours and setting limitations). A multifaceted strategy, which includes the use of reminders, audit and feedback, as well as the use of local opinion leaders, can be more effective than a single intervention (3).
FIRST CONTACT (PRIMARY CARE) LEVEL
The studies included in the systematic review were mainly focused on physicians’ behaviour and hospital facilities. It is not known whether the effectiveness of local opinion leaders would be different at the primary care level. Nevertheless, it is possible that some characteristics of the primary care level in many developing countries may favour implementation of this intervention. This level of care is frequently understaffed and the possibilities of training are limited owing to time constraints, heavy workload and scarce resources. Informal exchange of information between health-care providers is common at this level. It is my opinion that, in under-resourced settings, the local opinion leader is often the single available knowledge source for his/her peers, and therefore could act as an agent of change.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
The recommendations for the primary care level also apply to this level.
AT HOME OR IN THE COMMUNITY
- 1. Sisk JE, Greer AL, Wojtowycz M, Pincus LB, Aubry RH. Implementing evidence-based practice: Evaluation of an opinion leader strategy to improve breast-feeding rates. Am J Obstet Gynecol 2004;190:413-21. Medline
- 2. Kravitz RL, Krackhardt D, Melnikow J, Franz CE, Gilbert WM, Zach A, et al. Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery. Soc Sci Med 2003;57:2423-34. Medline
- 3. Chaillet N, Dubé E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al. Evidence-Based Strategies for Implementing Guidelines in Obstetrics: A Systematic Review. Obstet Gynecol 2006;108:1234-45. Medline
This document should be cited as: Souza JP. Local opinion leaders: RHL practical aspects (last revised: 17 July 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.