Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery

Richard L Kravitz, David Krackhardt, Joy Melnikow, Carol E. Franz, William M. Gilbert, Andra Zach, Debora A Paterniti, Patrick S Romano

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of "opinion leadership". All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.

Original languageEnglish (US)
Pages (from-to)2423-2434
Number of pages12
JournalSocial Science and Medicine
Volume57
Issue number12
DOIs
StatePublished - Dec 2003

Fingerprint

opinion leader
obstetrics
Obstetrics
High-Volume Hospitals
Healthy People Programs
Demography
Nurse Midwives
Family Physicians
family physician
midwife
survey design
Language
random sample
Mothers
Medicine
opinion
Opinion leaders
medicine
leadership
nurse

Keywords

  • Caesarean section
  • Obstetricians
  • Opinion leaders
  • USA

ASJC Scopus subject areas

  • Economics and Econometrics
  • Public Health, Environmental and Occupational Health
  • Social Psychology
  • Development
  • Health(social science)

Cite this

Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery. / Kravitz, Richard L; Krackhardt, David; Melnikow, Joy; Franz, Carol E.; Gilbert, William M.; Zach, Andra; Paterniti, Debora A; Romano, Patrick S.

In: Social Science and Medicine, Vol. 57, No. 12, 12.2003, p. 2423-2434.

Research output: Contribution to journalArticle

@article{d1ac0db8bd0c4ec5ae267327fe4ff6ea,
title = "Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery",
abstract = "The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8{\%}) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of {"}opinion leadership{"}. All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31{\%} of California hospitals; they were identified in 81{\%} of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48{\%} of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.",
keywords = "Caesarean section, Obstetricians, Opinion leaders, USA",
author = "Kravitz, {Richard L} and David Krackhardt and Joy Melnikow and Franz, {Carol E.} and Gilbert, {William M.} and Andra Zach and Paterniti, {Debora A} and Romano, {Patrick S}",
year = "2003",
month = "12",
doi = "10.1016/S0277-9536(03)00137-0",
language = "English (US)",
volume = "57",
pages = "2423--2434",
journal = "Social Science and Medicine",
issn = "0277-9536",
publisher = "Elsevier Limited",
number = "12",

}

TY - JOUR

T1 - Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery

AU - Kravitz, Richard L

AU - Krackhardt, David

AU - Melnikow, Joy

AU - Franz, Carol E.

AU - Gilbert, William M.

AU - Zach, Andra

AU - Paterniti, Debora A

AU - Romano, Patrick S

PY - 2003/12

Y1 - 2003/12

N2 - The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of "opinion leadership". All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.

AB - The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of "opinion leadership". All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.

KW - Caesarean section

KW - Obstetricians

KW - Opinion leaders

KW - USA

UR - http://www.scopus.com/inward/record.url?scp=0142248888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0142248888&partnerID=8YFLogxK

U2 - 10.1016/S0277-9536(03)00137-0

DO - 10.1016/S0277-9536(03)00137-0

M3 - Article

C2 - 14572848

AN - SCOPUS:0142248888

VL - 57

SP - 2423

EP - 2434

JO - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

IS - 12

ER -