{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:47:20Z","timestamp":1773787640875,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intrapartum care (IPC), medical support during labor from onset to 2 h post-placenta delivery, is vital for maternal and newborn health. Quality IPC relies on healthcare providers\u2019 knowledge and practices. Deficiencies in either case cause adverse outcomes. This study examines the knowledge\u2013practice gap [know\u2013do gap (KDG)] among IPC providers in Dire Dawa Administration (DDA), Eastern Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the Fenot project in DDA (December 2020\u2013May 2021) that included nine health facilities, 84 providers, and 865 labor observations were used. A structured questionnaire assessed knowledge, and direct observation evaluated practices. The KDG was analyzed across six labor and postpartum domains, comparing the observed practices to knowledge reported. Gaps were categorized as know\u2013do match, knowledge\u2013action deficit, or practice surplus. Multinomial logistic regression was performed using STATA 17. The KDG scoring system used binary coding (1 for \u201cknown\/done,\u201d 0 for \u201cunknown\/not done\u201d) across domains, with scores aggregated as percentages. Assumptions for the multinomial logistic regression were checked via Hausman tests, and model fit was assessed using likelihood ratio tests, confirming good fit (P\u2009&amp;lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall knowledge of IPC was 69.52%, practice was 59.04% and KDG was 10.48%. Knowledge\u2013action alignment was low: 12.80% (initial labor), 14.30% (first stage), 15.90% (second stage), 14.70% (third stage), 14.90% (neonatal care), and 14.60% (postnatal care). Only 11% of providers showed a complete know\u2013do match, 26.20% had a practice surplus, and 62.80% had a knowledge\u2013action deficit. Multinomial logistic regression revealed a reduced practice surplus with increasing years of service (adjusted Relative Risk Ratio (aRRR)\u2009=\u20090.81; 95% CI: 0.73\u20130.89) and in-service training (aRRR\u2009=\u20090.52; 95% CI: 0.29\u20130.94). Knowledge\u2013action deficits were associated with to female providers (aRRR\u2009=\u20090.43; 95% CI: 0.23\u20130.80), additional roles (aRRR\u2009=\u20094.00; 95% CI: 2.38\u20136.68), provider type (aRRR\u2009=\u20093.79; 95% CI: 1.06\u201313.56), and rural facilities (aRRR\u2009=\u20092.00; 95% CI: 1.16\u20133.46).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A significant knowledge\u2013practice gap exists in IPC. Factors such as facility location, provider type, gender, experience, and dual roles contribute to this gap. Providers should follow established guidelines and pursue ongoing training to enhance their skills. Health systems must address training, resources, supervision, and mentoring to reduce KDG and enhance IPC quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzaf136","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T13:02:47Z","timestamp":1766581367000},"source":"Crossref","is-referenced-by-count":0,"title":["The know\u2013do gap among intrapartum care providers in the Dire Dawa Administration, Eastern Ethiopia"],"prefix":"10.1093","volume":"38","author":[{"given":"Moti","family":"Tolera","sequence":"first","affiliation":[{"name":"School of Public Health, College of Health and Medical Sciences, Haramaya University , Harar, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yadeta","family":"Dessie","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health and Medical Sciences, Haramaya University , Harar, Ethiopia"},{"name":"African Population and Health Research Center , Nairobi,","place":["Kenya"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsinuel","family":"Girma","sequence":"additional","affiliation":[{"name":"Fenot, Harvard T.H. Chan School of Public Health , Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret E","family":"Kruk","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bereket","family":"Yakob","sequence":"additional","affiliation":[{"name":"Fenot, Harvard T.H. Chan School of Public Health , Addis Ababa, Ethiopia"},{"name":"School of Nursing and Public Health, College of Health Sciences, University of KwaZulu\u2013Natal , Durban,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026031715152257700_mzaf136-B1","doi-asserted-by":"crossref","first-page":"2885","DOI":"10.1136\/bmj.p2885","article-title":"Intrapartum care\u2013updated summary of NICE guidance","volume":"384","author":"Blackburn","year":"2024","journal-title":"BMJ"},{"key":"2026031715152257700_mzaf136-B2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s40359-020-00410-8","article-title":"A systematic review regarding women\u2019s emotional and psychological experiences of high-risk pregnancies","volume":"8","author":"Isaacs","year":"2020","journal-title":"BMC Psychol"},{"key":"2026031715152257700_mzaf136-B3","volume-title":"Integrated Management of Pregnancy and Childbirth, in Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors","author":"WHO","year":"2017"},{"key":"2026031715152257700_mzaf136-B4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12884-023-06199-9","article-title":"Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis","volume":"24","author":"Baykemagn","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026031715152257700_mzaf136-B5","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1186\/s12889-023-16558-y","article-title":"Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and Middle-income countries: a review of systematic reviews","volume":"23","author":"Mzembe","year":"2023","journal-title":"BMC Public Health"},{"key":"2026031715152257700_mzaf136-B6","first-page":"1","author":"WHO","year":"2019"},{"key":"2026031715152257700_mzaf136-B7","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1186\/s12884-020-03110-8","article-title":"Factors influencing utilization of skilled birth attendant during childbirth in the Southern Highlands, Tanzania: a multilevel analysis","volume":"20","author":"Damian","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026031715152257700_mzaf136-B8","volume-title":"Maternal Mortality","author":"WHO","year":"2023"},{"key":"2026031715152257700_mzaf136-B9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12961-020-00621-w","article-title":"Bridging the research\u2013practice gap in healthcare: a rapid review of research translation centres in England and Australia","volume":"18","author":"Robinson","year":"2020","journal-title":"Health Res Policy Syst"},{"key":"2026031715152257700_mzaf136-B10","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12978-021-01109-8","article-title":"Assessment of midwifery care providers intrapartum care competencies, in four sub-Saharan countries: a mixed-method study protocol","volume":"18","author":"Moller","year":"2021","journal-title":"Reprod Health"},{"key":"2026031715152257700_mzaf136-B11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/chp.47","article-title":"Lost in knowledge translation: time for a map?","volume":"26","author":"Graham","year":"2006","journal-title":"J Contin Educ Health Prof"},{"key":"2026031715152257700_mzaf136-B12","author":"Madeline","year":"2020"},{"key":"2026031715152257700_mzaf136-B13","first-page":"1189","article-title":"Learning from one another to bridge the \u201cknow-do gap\u201d","author":"Pakenham-Walsh","year":"2004"},{"key":"2026031715152257700_mzaf136-B14","author":"Marahatta","year":"2012"},{"key":"2026031715152257700_mzaf136-B15","first-page":"210","article-title":"What we do and don\u2019t know: a meta-analysis of the knowledge gap hypothesis","volume":"43","author":"Lind","year":"2019","journal-title":"Ann Int Commun Assoc"},{"key":"2026031715152257700_mzaf136-B16","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1186\/s12884-022-05065-4","article-title":"Midwives\u2019 knowledge and practice of respectful maternity care: a survey from Iran","volume":"22","author":"Moridi","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026031715152257700_mzaf136-B17","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/s12905-024-03177-x","article-title":"Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review","volume":"24","author":"Sarikhani","year":"2024","journal-title":"BMC Womens Health"},{"key":"2026031715152257700_mzaf136-B18","doi-asserted-by":"crossref","first-page":"e0000157","DOI":"10.1371\/journal.pgph.0000157","article-title":"A qualitative enquiry of health care workers\u2019 narratives on knowledge and sources of information on principles of respectful maternity care (RMC)","volume":"3","author":"Lusambili","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2026031715152257700_mzaf136-B19","doi-asserted-by":"crossref","first-page":"e066111","DOI":"10.1136\/bmjopen-2022-066111","article-title":"The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia","volume":"12","author":"Gage","year":"2022","journal-title":"BMJ Open"},{"key":"2026031715152257700_mzaf136-B20","author":"DDA Health Bureau","year":"2024"},{"key":"2026031715152257700_mzaf136-B21","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1377\/hlthaff.2015.0902","article-title":"Evaluation of a maternal health program in Uganda and Zambia finds mixed results on quality of care and satisfaction","volume":"35","author":"Kruk","year":"2016","journal-title":"Health Aff (Millwood)"},{"key":"2026031715152257700_mzaf136-B22","volume-title":"WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience","author":"WHO","year":"2018"},{"key":"2026031715152257700_mzaf136-B23","volume-title":"NICE Guideline","author":"Intrapartum","year":"2023"},{"key":"2026031715152257700_mzaf136-B24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13012-014-0172-2","article-title":"Using the knowledge to action framework in practice: a citation analysis and systematic review","volume":"9","author":"Field","year":"2014","journal-title":"Implement Sci"},{"key":"2026031715152257700_mzaf136-B25","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1186\/s12884-023-06118-y","article-title":"Promoting a global culture of respectful maternity care","volume":"23","author":"Puthussery","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026031715152257700_mzaf136-B26","doi-asserted-by":"crossref","first-page":"e000983","DOI":"10.1136\/bmjoq-2020-000983","article-title":"Improving knowledge translation for increased engagement and impact in healthcare","volume":"9","author":"Eljiz","year":"2020","journal-title":"BMJ Open Qual"},{"key":"2026031715152257700_mzaf136-B27","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1478-4491-11-51","article-title":"Effective in-service training design and delivery: evidence from an integrative literature review","volume":"11","author":"Bluestone","year":"2013","journal-title":"Hum Resour Health"},{"key":"2026031715152257700_mzaf136-B28","author":"Pamela","year":"2024"},{"key":"2026031715152257700_mzaf136-B29","author":"Cherry"},{"key":"2026031715152257700_mzaf136-B30","first-page":"675","volume":"19"}],"container-title":["International Journal For Quality In Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/intqhc\/advance-article-pdf\/doi\/10.1093\/intqhc\/mzaf136\/66140438\/mzaf136.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/1\/mzaf136\/66140438\/mzaf136.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/1\/mzaf136\/66140438\/mzaf136.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:15:31Z","timestamp":1773774931000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/doi\/10.1093\/intqhc\/mzaf136\/8405752"}},"subtitle":[],"editor":[{"given":"Yingxi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,10]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzaf136","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"value":"1353-4505","type":"print"},{"value":"1464-3677","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,12,30]]},"article-number":"mzaf136"}}