Evidence-Based Practice, Research and Health Promotion
This domain tests whether you can read a paper, apply its result to a Mongolian woman, and design an education activity that changes behaviour rather than merely delivering information.
Appraisal essentials
Form a PICO question, then rank the evidence: systematic reviews and randomised trials above cohort studies, above case reports and expert opinion. Check allocation, blinding, completeness of follow-up and whether outcomes are patient-important. Convert relative to absolute risk: a 40% relative reduction from 10% to 6% means four fewer cases per 100 women, an NNT of 25.
Applying evidence
Evidence from high-income hospitals does not transfer automatically. Ask whether the population, baseline risk and resources match. Delayed cord clamping, antenatal corticosteroids and magnesium sulfate have strong evidence and low cost - these are the interventions to defend.
Health promotion
Information alone rarely changes behaviour. Combine it with enabling factors: a place to sit, a companion, transport, free supplies. Use plain language, teach-back and family involvement. Research involving pregnant women needs ethics committee approval, genuine informed consent and protection of confidentiality.
Worked example
A colleague claims a herbal tea shortens labour. Reasoning: search for systematic reviews, find none of adequate quality, recognise that absence of evidence is not evidence of benefit or harm, discuss contamination risk, and tell the woman no reliable evidence supports it while respecting her choice.
Traps
Confusing relative with absolute risk; generalising from one small single-centre study; and assuming a leaflet constitutes a health-promotion programme.