The know–do gap among intrapartum care providers in the Dire Dawa Administration, Eastern Ethiopia

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INTRODUCTION: 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' knowledge and practices. Deficiencies in either case cause adverse outcomes. This study examines the knowledge-practice gap [know-do gap (KDG)] among IPC providers in Dire Dawa Administration (DDA), Eastern Ethiopia. METHODS: Data from the Fenot project in DDA (December 2020-May 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-do match, knowledge-action deficit, or practice surplus. Multinomial logistic regression was performed using STATA 17. The KDG scoring system used binary coding (1 for "known/done," 0 for "unknown/not done") 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 < .001). RESULTS: The overall knowledge of IPC was 69.52%, practice was 59.04% and KDG was 10.48%. Knowledge-action 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-do match, 26.20% had a practice surplus, and 62.80% had a knowledge-action deficit. Multinomial logistic regression revealed a reduced practice surplus with increasing years of service (adjusted Relative Risk Ratio (aRRR) = 0.81; 95% CI: 0.73-0.89) and in-service training (aRRR = 0.52; 95% CI: 0.29-0.94). Knowledge-action deficits were associated with to female providers (aRRR = 0.43; 95% CI: 0.23-0.80), additional roles (aRRR = 4.00; 95% CI: 2.38-6.68), provider type (aRRR = 3.79; 95% CI: 1.06-13.56), and rural facilities (aRRR = 2.00; 95% CI: 1.16-3.46). CONCLUSIONS: A significant knowledge-practice 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.

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