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Background: Using best evidence to inform practice is the cornerstone of quality patient care, and requires spread, uptake, implementation and roll-out of best practices. Kangaroo mother care (KMC) was used as a best practice which has been partly rolled-out in South Africa. In order for successful roll-out of best practices, it is important to understand what health professionals perceive as requirements for the rolling-out process. However, no published research was found on requirements for rolling-out a best practice in the South African context.Purpose of the research: To explore and describe the perspectives of health professionals on the requirements for the rolling-out process of KMC as a best practice in South Africa.Methodology: Twelve semi-structured individual interviews were conducted in 2012 with health professionals from various South African healthcare levels, involved in the implementation and the rolling-out process of kangaroo mother care. Content analysis were guided in terms of the four requirements for roll-out of best practices, identified in Edwards and Grinspun's Evidence Informed Model of Care.Results: The requirements for the successful rollout of best practices mentioned by the participants in this study concur with the requirements of Edwards and Grinspun: personal alignment and protocol/policy alignment with the best practice; a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists), management level (of the hospital), provincial level and national level.Conclusion: Although certain requirements, such as personal alignment and reinforcing structures can be used in the roll-out of best practices, further research is desirable to promote fuller understanding of how to devise and apply the requirements in the wider adoption of best practices in South African health care settings.Keywords: Benefit levers, Best practice, Health professionals, Kangaroo mother care, Requirements, Rolling-out process, South Africa

Between January 1989 and December 1992 in Osasco health district of Sao Paulo Brazil interviews were conducted with 1744 low-income women aged 15 years to more than 30 years at five public health clinics to determine the prevalence of diaphragm use and acceptability of the diaphragm. All the women chose a contraceptive method after attending an educational session on all contraceptive methods. The most common contraceptive methods chosen included the IUD (30.8%) oral contraceptives (OCs) (29.3%) and condoms (20.3%). 11.3% chose the diaphragm which was considerably higher than expected since it had only recently been introduced in Brazilian public health clinics. Diaphragm users were older and better educated than OC users (odds ratio [OR] = 1.8 p = .0018; and OR = 2.5 p = 0.00001 respectively). They were more likely than IUD users to use contraception for birth spacing than birth limiting (OR = 1.5 p = 0.0179). The leading reason for choosing the diaphragm was concern over health (35%) followed by easy to use (16.3%). The overwhelming key reason for not choosing the diaphragm was the perceived difficulties in handling it. About 46% of women who chose the diaphragm had discontinued use within three months. Discontinuation rates for the other methods were lower (29% for the condom 27% for the minipill 16% for OCs and 4% for the IUD). The two key reasons for discontinuation of the diaphragm were: contraception no longer needed (15.2%) and difficulties in inserting and removing the diaphragm (15.2%). Improved training and preparation of health professionals are likely to be key to expanding contraceptive options for Brazilian women in general and to making the diaphragm a viable alternatives for low-income women in particular. Yet current structural weaknesses in the Brazilian public health system do not guarantee the ongoing support needed to allow diaphragm users to resolve their initial problems with the methods or the level of educational efforts to adequately inform diaphragm users.