A large scale review, involving 100 trials, concluded that computer-based decision support systems can improve practitioner performance but that the effects of such interventions remain both understudied and inconsistent [ 13, 15].
We explore the role of the "reflective adaptive process" in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system.
While curricula on sexual history taking have been described, the impact of such interventions on resident physician performance of the sexual history remains unknown.
It is thus not surprising that most of such interventions are sub-optimal in performance [ 25].
Rigorous evaluation studies, accompanying the implementation of such interventions, will contribute to our understanding of their performance and impact on patient healthcare expenditures and population health outcomes.
Consequently, interventions to improve performance will vary for each indicator and may include the need to educate patients about the value of such interventions, to increase demand and clinician confidence in delivery.
However, robust data demonstrating effectiveness of such interventions are lacking.
Robust evaluations of such interventions are urgently required.
No evidence supports the efficacy of such interventions to change sexual orientation or gender identity, and such interventions are potentially harmful.
