PT - JOURNAL ARTICLE AU - Catherine Arsenault AU - Samantha Y Rowe AU - Dennis Ross-Degnan AU - David H Peters AU - Sanam Roder-DeWan AU - Margaret E Kruk AU - Alexander K Rowe TI - How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review AID - 10.1136/bmjqs-2020-011717 DP - 2022 Feb 01 TA - BMJ Quality & Safety PG - 123--133 VI - 31 IP - 2 4099 - http://qualitysafety.bmj.com/content/31/2/123.short 4100 - http://qualitysafety.bmj.com/content/31/2/123.full SO - BMJ Qual Saf2022 Feb 01; 31 AB - Background A recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability.Methods We conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance.Results The primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI: –0.36 to –0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI: –0.68 to –0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time.Conclusions Time trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.Data are available in a public, open access repository. The STATA code, data and an associated data dictionary are publicly available and can be found at: https://github.com/catherine-arsenault/Do-files-change-in-effectiveness-HCPPR-2020. Other data issued from the Health Care Provider Performance Review (HCPPR) can be found at: http://www.HCPperformancereview.org.