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Bonet M, Ciabati L, De Oliveira LL, Souza R, Browne JL, Rijken M, Fawcus S, Hofmeyr GJ, Liabsuetrakul T, Gülümser Ç, Blennerhassett A, Lissauer D, Meher S, Althabe F, Oladapo OT. Constructing evidence-based clinical intrapartum care algorithms for decision-support tools. BJOG 2024; 131 Suppl 2:6-16. [PMID: 35411684 DOI: 10.1111/1471-0528.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours. POPULATION Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility. SETTING Health facilities in low- and middle-income countries. SEARCH STRATEGY Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google. CASE SCENARIOS Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes. CONCLUSIONS Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts. TWEETABLE ABSTRACT Evidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience.
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Affiliation(s)
- M Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - L Ciabati
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L L De Oliveira
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - R Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - J L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - M Rijken
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G J Hofmeyr
- Effective Care Research Unit, Walter Sisulu University and Eastern Cape Department of Health, University of the Witwatersrand, East London, South Africa
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - T Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ç Gülümser
- Department of Obstetrics and Gynecology, University of Health Science School of Medicine, Ankara, Turkey
| | - A Blennerhassett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- World Health Organization Collaborating Centre for Global Women's Health Research, Birmingham, UK
| | - D Lissauer
- Malawi-Liverpool-Wellcome Trust Research Institute, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool, UK
| | - S Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - F Althabe
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Getaneh FB, Asmare A, Abayneh B, Birre E, Mohammed A, Muche A, Gedefie A, Asmamaw Y, Mengesha Z, Moges N, Birhanu DM, Bitew ZW, Molla A. Infection in preterm infants receiving topical emollient oil massage: a systematic review and meta-analysis of randomised control trials. BMJ Paediatr Open 2024; 8:e002364. [PMID: 38986540 PMCID: PMC11243225 DOI: 10.1136/bmjpo-2023-002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/20/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Preterm infants are highly susceptible to infections, which significantly contribute to morbidity and mortality. This systematic review and meta-analysis investigated the effectiveness of topical emollient oil application in preventing infections among preterm infants. METHODS A comprehensive search was conducted across multiple electronic databases (PubMed, Cochrane, Scopus, Clinical trials, Epistemonikos, HINARI and Global Index Medicus) and other sources. A total of 2185 articles were identified and screened for eligibility. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for randomised controlled trials. Data analysis was performed using StataCrop MP V.17 software. Heterogeneity among the studies was evaluated using the I2 and Cochrane Q test statistics. Sensitivity and subgroup analyses were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist guided the presentation of the results. RESULTS Of 2185 retrieved articles from initial searches, 11 met eligibility criteria and were included in the final analysis. A random effects meta-analysis revealed that infants who received massages with emollient oils had a 21% reduced risk of infection (risk ratio=0.79, 95% CI 0.64 to 0.97, I2=0.00%). Subgroup analyses indicated that preterm babies who received topical emollient oil massages with coconut oil, administered twice a day for more than 2 weeks, had a lower likelihood of acquiring an infection compared with their non-massaged counterparts. CONCLUSION It is quite evident from this analysis that topical emollient oil application in preterm neonates is most likely effective in preventing infection. However, further studies, particularly from the African continent, are warranted to support universal recommendations.
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Affiliation(s)
| | | | | | - Endalk Birre
- Pediatrics and child health nursing, Wollo University, Dessie, Ethiopia
| | | | - Amare Muche
- Public health, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Medical Laboratory, Wollo University, Dessie, Ethiopia
| | - Yibeltal Asmamaw
- Pediatrics and child health nursing, Wollo University, Dessie, Ethiopia
| | | | - Natnael Moges
- Pediatrics and child health Nursing, Debre Tabor Univeristy, Debre Tabor, Ethiopia
| | - Dires Mihretie Birhanu
- Pediatrics and child health nursing, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Zebenay Workneh Bitew
- Pediatrics and child health nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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3
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Lewin S, Langlois EV, Tunçalp Ö, Portela A. Assessing unConventional Evidence (ACE) tool: development and content of a tool to assess the strengths and limitations of 'unconventional' source materials. Health Res Policy Syst 2024; 22:2. [PMID: 38167048 PMCID: PMC10759469 DOI: 10.1186/s12961-023-01080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND When deciding whether to implement an intervention, decision-makers typically have questions on feasibility and acceptability and on factors affecting implementation. Descriptions of programme implementation and of policies and systems are rich sources of information for these questions. However, this information is often not based on empirical data collected using explicit methods. To use the information in unconventional source materials in syntheses or other decision support products, we need methods of assessing their strengths and limitations. This paper describes the development and content of the Assessing unConventional Evidence (ACE) tool, a new tool to assess the strengths and limitations of these sources. METHODS We developed the ACE tool in four stages: first, we examined existing tools to identify potentially relevant assessment criteria. Second, we drew on these criteria and team discussions to create a first draft of the tool. Third, we obtained feedback on the draft from potential users and methodologists, and through piloting the tool in evidence syntheses. Finally, we used this feedback to iteratively refine the assessment criteria and to improve our guidance for undertaking the assessment. RESULTS The tool is made up of 11 criteria including the purpose and context of the source; the completeness of the information presented; and the extent to which evidence is provided to support the findings made. Users are asked to indicate whether each of the criteria have been addressed. On the basis of their judgements for each criterion, users then make an overall assessment of the limitations of the source, ranging from no or very minor concerns to serious concerns. These assessments can then facilitate appropriate use of the evidence in decision support products. CONCLUSIONS Through focussing on unconventional source materials, the ACE tool fills an important gap in the range of tools for assessing the strengths and limitations of policy-relevant evidence and supporting evidence-informed decision-making.
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Affiliation(s)
- Simon Lewin
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology, Ålesund, Norway.
- Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health, Oslo, Norway.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Esteves Mills J, Thomas A, Abdalla N, El-Alam R, Al-Shabi K, Ashinyo ME, Bangoura FO, Charles K, Chipungu J, Cole AO, Engebretson B, Goyol K, Grasham CF, Grossi V, Hickling S, Kalandarov S, Ababu AK, Kholmuhammad K, Klaesener-Metzner N, Kugedera Z, Kwakye A, Lee-Llacer A, Maani PP, Makhafola B, Mohamed A, Monirul Alam M, Monse B, Northover H, Palomares A, Patabendi N, Paynter N, Prasad-Gautam O, Panthi SR, Rudge L, Saha S, Salaru I, Saltiel G, Sax L, Shahid MA, Gafur MS, Shrestha S, Szeberényi K, Tidwell JB, Trinies V, Yiha O, Ziganshin R, Gordon B, Cumming O. How can global guidelines support sustainable hygiene systems? BMJ Glob Health 2023; 8:e013632. [PMID: 37879652 PMCID: PMC10603483 DOI: 10.1136/bmjgh-2023-013632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Joanna Esteves Mills
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Ann Thomas
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Nadia Abdalla
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Rola El-Alam
- WHO Regional Office for the Eastern Mediterranean, Amman, Jordan
| | | | | | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research, Zambia (CIDRZ), Lusaka, Zambia
| | | | - Betsy Engebretson
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Kitka Goyol
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Valentina Grossi
- European Centre for Environment & Health, WHO Regional Office for Europe, Bonn, Germany
| | | | | | | | | | | | | | | | - Andrea Lee-Llacer
- Department of Health, Government of the Philippines, Manila, Philippines
| | - Pauke P Maani
- Department of Public Health, Ministry of Health, Funafuti, Tuvalu
| | - Belinda Makhafola
- Ministry of Health, Government of South Africa, Pretoria, South Africa
| | | | | | - Bella Monse
- German Agency for International Cooperation, Bonn, Germany
| | | | - Aarin Palomares
- Global Handwashing Partnership, Washington, District of Columbia, USA
| | | | | | | | - Sudan Raj Panthi
- Environmental Health, World Health Organization, Kathmandu, Nepal
| | - Lisa Rudge
- Foreign Commonwealth & Development Office, Government of the United Kingdom, London, UK
| | | | - Ion Salaru
- National Agency for Public Health, Government of the Republic of Moldova, Chisinau, Moldova (the Republic of)
| | | | - Laurent Sax
- Health Emergency Interventions, WHO, Geneva, Switzerland
| | - Mir Abdus Shahid
- Department of Public Health Engineering, Government of Bangladesh, Dhaka, Bangladesh
| | | | | | - Katalin Szeberényi
- National Center for Public Health, Government of Hungary, Budapest, Hungary
| | | | - Victoria Trinies
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Osman Yiha
- WHO Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Bruce Gordon
- Water, Sanitation, Hygiene and Health Unit, Department of Environment, Climate Change and Health, World Health Organization (WHO), Geneva, Switzerland
| | - Oliver Cumming
- London School of Hygiene and Tropical Medicine, London, UK
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5
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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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6
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Wang Q, Zhu Y, Xie S, Kibria MG, Guo Q, Belal AA, Li Y, Zhang J, Chen Y, Schünemann HJ, Wilson MG, Yang K, Lavis JN. Facilitators, barriers and strategies for health-system guidance implementation: a critical interpretive synthesis protocol. Health Res Policy Syst 2022; 20:105. [PMID: 36175897 PMCID: PMC9523963 DOI: 10.1186/s12961-022-00908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background As systematically developed statements regarding possible courses of action, health system guidance (HSG) can assist with making decisions about addressing problems or achieving goals in health systems. However, there are conceptual and methodological challenges in HSG implementation due to the complexity of health-system policy-making, the diversity of available evidence and vast differences in contexts. To address these gaps, we aim to develop a theoretical framework for supporting HSG implementation as part of a broader effort to promote evidence-informed policy-making in health systems. Methods To develop a theoretical framework about facilitators, barriers and strategies for HSG implementation, we will apply a critical interpretive synthesis (CIS) approach to synthesize the findings from a range of relevant literature. We will search 11 electronic databases and seven organizational websites to identify relevant published and grey literature. We will check the references of included studies and contact experts to identify additional eligible papers. Finally, we will conduct purposively sampling of the literature to fill any identified conceptual gaps. We will use relevance and five quality criteria to assess included papers. A standardized form will be developed for extracting information. We will use an interpretive analytic approach to synthesize the findings, including a constant comparative method throughout the analysis. Two independent reviewers will conduct the literature screening and relevance assessment, and disagreements will be resolved through discussion. The principal investigator will conduct data extraction and synthesis, and a second reviewer will check the sample of extracted data for consistency and accuracy. Discussion A new theoretical framework about facilitators, barriers and strategies for HSG implementation will be developed using a CIS approach. The HSG implementation framework could be widely used for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle- and high-income countries). In later work, we will develop a tool for supporting HSG implementation based on the theoretical framework. Registration PROSPERO CRD42020214072. Date of Registration: 14 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00908-0.
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Affiliation(s)
- Qi Wang
- Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shitong Xie
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | | | - Qiangqiang Guo
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ahmed Atef Belal
- Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Yanfei Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Kehu Yang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China. .,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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7
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Breneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, Langlois EV, Wozney L, Vélez CM, Cassidy C, Juvekar S, Rothfus M, Aziato L, Keeping-Burke L, Adjorlolo S, Patiño-Lugo DF. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Health Res Policy Syst 2022; 20:64. [PMID: 35706039 PMCID: PMC9202131 DOI: 10.1186/s12961-022-00865-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada.
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Kirti Minocha
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Catie Johnson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Helen Wong
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Lori Wozney
- Nova Scotia Health Authority Policy and Planning, Dartmouth, Canada
| | - C Marcela Vélez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Melissa Rothfus
- W.K. Kellogg Health Science Library, Dalhousie University, Halifax, Canada
| | - Lydia Aziato
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, St. John, Canada
| | - Samuel Adjorlolo
- Department of Mental Health Nursing, University of Ghana, Legon, Accra, Ghana
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8
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Narh-Bana SA, Chirwa TF, Chirwa ED, Bonsu F, Ibisomi L, Kawonga M. Adherence of HIV clinics to guidelines for the delivery of TB screening among people living with HIV/AIDS in Ghana. BMC Health Serv Res 2021; 21:1110. [PMID: 34656125 PMCID: PMC8520611 DOI: 10.1186/s12913-021-07121-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022] Open
Abstract
Background Tuberculosis screening of people living with HIV (PLHIV) – an intervention to reduce the burden of TB among PLHIV – is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana. Methods This cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics. Results From the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5–100.0), 0% (IQR: 0–66.7), 33.3% (IQR: 33.3–50.0), and 90.0% (IQR: 70.0–90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6–65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60–904) vs. 900 (IQR: 609–2622); p = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6–113) vs. 90 (IQR: 66.7–263.5); p = 0.046), and most had screening guidelines (76%, p < 0.01) and questionnaire (80%, p < 0.01) available on-site. Conclusion PRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07121-9.
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Affiliation(s)
- Solomon A Narh-Bana
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana.
| | - Tobias F Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Esnat D Chirwa
- Gender & Health Research Unit, Medical Research Council, Johannesburg, South Africa
| | | | - Latifat Ibisomi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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do Nascimento JC, Sanches MB, Souza RCS. Validation of guidelines for the care of patients undergoing continuous renal replacement therapy. Nurs Crit Care 2021; 28:379-387. [PMID: 34585485 DOI: 10.1111/nicc.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Continuous renal replacement therapy is one of the most frequently used treatments for acute kidney injury (AKI) in intensive care units (ICUs). It requires professionals with specialized knowledge, specific facilities, and care guidelines to ensure appropriate clinical practice. AIMS AND OBJECTIVES To validate the care guidelines for patients undergoing continuous renal replacement therapy. METHOD This is a methodological study regarding consensual validation of the directives of care. These directives followed the formulation of the research question, a literature review, elaboration of the directive, and validation of the agreement by a committee consisting of seven expert judges. RESULTS The data were analysed based on the content validity index and described in four categories. Among 40 care-related items, 95% showed a degree of agreement above 80% for adequacy and 82.5% showed a degree of agreement above 75% for relevance. CONCLUSION The care-related items identified in the literature showed a high percentage of agreement among the judges and reflected the treatment requirements of these patients. RELEVANCE TO CLINICAL PRACTICE The guideline will be important to assist in the care process regarding patient safety and quality of care.
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10
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Wang Z, Grundy Q, Parker L, Bero L. Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines. BMC Public Health 2020; 20:1758. [PMID: 33228608 PMCID: PMC7686668 DOI: 10.1186/s12889-020-09812-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines. METHODS A grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding. RESULTS We categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines. CONCLUSIONS In comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances. ETHICS This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).
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Affiliation(s)
- Zhicheng Wang
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, Australia
| | - Quinn Grundy
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, Australia
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lisa Parker
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, Australia
| | - Lisa Bero
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, Australia
- Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, USA
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11
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What Is Dissemination and Implementation Science?: An Introduction and Opportunities to Advance Behavioral Medicine and Public Health Globally. Int J Behav Med 2020; 27:3-20. [PMID: 32060805 DOI: 10.1007/s12529-020-09848-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There has been a well-documented gap between research (e.g., evidence-based programs, interventions, practices, policies, guidelines) and practice (e.g., what is routinely delivered in real-world community and clinical settings). Dissemination and implementation (D&I) science has emerged to address this research-to-practice gap and accelerate the speed with which translation and real-world uptake and impact occur. In recent years, there has been tremendous development in the field and a growing global interest, but much of the introductory literature has been U.S.-centric. This piece provides an introduction to D&I science and summarizes key concepts and progress of the field for a global audience, provides two case studies that highlight examples of D&I research globally, and identifies opportunities and innovations for advancing the field of D&I research globally.
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12
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Kerins C, McHugh S, McSharry J, Reardon CM, Hayes C, Perry IJ, Geaney F, Seery S, Kelly C. Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review. Int J Behav Nutr Phys Act 2020; 17:48. [PMID: 32295647 PMCID: PMC7161210 DOI: 10.1186/s12966-020-00948-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Sheena McHugh
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - Caitlin M Reardon
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Catherine Hayes
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin Russell Centre, Tallaght Cross, Dublin 24, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Suzanne Seery
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland
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Dantas JAR, Singh D, Lample M. Factors affecting utilization of health facilities for labour and childbirth: a case study from rural Uganda. BMC Pregnancy Childbirth 2020; 20:39. [PMID: 31948413 PMCID: PMC6966848 DOI: 10.1186/s12884-019-2674-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since 2000 considerable attention has been placed on maternal health outcomes as the 5th Millennium Goal. In Uganda, only 65% of births are delivered by a skilled birth attendant, contributing to the 435 women that die in every 100,000 births from unattended complications. Factors that impact a women's decision on where to deliver include cost and household barriers, poor health services and lack of education. METHODS Insight into factors impacting maternal health decision-making in two villages in South Eastern Uganda, were explored through a cross-sectional study using focus group discussions (FDGs) with men and women and administering a simple questionnaire. RESULTS For men and women in the villages, cultural and community patterns of behavior have the strongest impact on delivery options. While women with no complications could often find options to deliver safely, lack of emergency obstetric care remains a strong factor in maternal deaths. CONCLUSIONS This article proposes that communities be engaged in identifying and leveraging their strengths to find solutions for challenges facing women in achieving safe deliveries.
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Affiliation(s)
- Jaya A R Dantas
- International Health Programme, School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia.
| | - Debra Singh
- Kimanya-Ngeyo Foundation for Science and Education, Plot no. 51, Main Street, Apartment 1, 1600, Jinja, Uganda
| | - May Lample
- The Office of Public Affairs of the Baha'is of the United States, 1320 19th Street, NW, Washington, DC, 20036, USA
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Wang Z, Grundy Q, Parker L, Bero L. Health promoter, advocate, legitimiser - the many roles of WHO guidelines: a qualitative study. Health Res Policy Syst 2019; 17:96. [PMID: 31805956 PMCID: PMC6896683 DOI: 10.1186/s12961-019-0489-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Properly implemented evidence-based clinical and public health guidelines can improve patient outcomes. WHO has been a major contributor to guideline development, publishing more than 250 guidelines on various topics since 2008. However, well-developed guidelines can only be effective if they are adequately and appropriately implemented. Herein, we aimed to explore whether and how WHO guidelines are implemented in local contexts to inform the success of future guideline implementation. METHODS Seventeen interviews were carried out between March 2018 and December 2018 with WHO guideline developers, headquarter staff, and regional and country office staff. Participants were purposely sampled from a variety of WHO guidelines and snowball sampling was used to identify regional and country office staff. The deidentified transcripts were analysed through three phases of coding, using grounded theory as the analytic approach. RESULTS WHO guidelines played a variety of roles in the work of WHO at all levels. WHO officers and local government officials used WHO guidelines to influence health policy. We categorised the uses of guidelines as (1) directly changing policy, (2) justifying policy change, (3) engaging stakeholders, (4) being guarantors of legitimacy, (5) being advocacy tools, and (6) intertwining with WHO's various roles. Participants refuted the perception of the guidelines as mere lists of technical recommendations that needed to be implemented in different contexts. We found that the existence, quality and credibility, rather than the content of the guidelines, are the keys to health policy change initiatives in different local contexts. CONCLUSIONS Used as a guarantor of legitimacy by policy-makers, WHO guidelines can be better positioned to influence health policy and practice change. Understanding the various roles of guidelines can help WHO developers package guidelines to optimise their effective implementation. ETHICS This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).
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Affiliation(s)
- Zhicheng Wang
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
| | - Quinn Grundy
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lisa Parker
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
| | - Lisa Bero
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
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15
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Alvarez E, Lavis JN, Brouwers M, Carmona Clavijo G, Sewankambo N, Solari L, Schwartz L. Developing evidence briefs for policy: a qualitative case study comparing the process of using a guidance-contextualization workbook in Peru and Uganda. Health Res Policy Syst 2019; 17:89. [PMID: 31752888 PMCID: PMC6868683 DOI: 10.1186/s12961-019-0488-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Translating research evidence from global guidance into policy can help strengthen health systems. A workbook was developed to support the contextualization of the WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance. This study evaluated the use of the workbook for the development of evidence briefs in two countries - Peru and Uganda. Findings surrounding contextual factors, steps in the process and evaluation of the workbook are presented. METHODS A qualitative embedded case study was used. The case was the process of using the workbook to support the contextualization of global health systems guidance, with local evidence, to develop evidence briefs. Criterion sampling was used to select the countries, participants for interviews and documents included in the study. A template-organizing style and constant comparison were used for data analysis. RESULTS A total of 19 participant-observation sessions and 8 interviews were conducted, and 50 documents were reviewed. Contextual factors, including the cadres, or groups, of health workers available in each country, the way the problem and its causes were framed, potential policy options to address the problem, and implementation considerations for these policy options, varied substantially between Peru and Uganda. However, many similarities were found in the process of using the workbook. Overall, the workbook was viewed positively and participants in both countries would use it again for other topics. CONCLUSIONS Organizations that produce global guidance, such as WHO, need to consider institutionalizing the application of the workbook into their guidance development processes to help users at the national/subnational level create actionable and context-relevant policies. Feedback mechanisms also need to be established so that the evidence briefs and health policies arising from global guidance are tracked and the findings coming out of such guideline contextualization processes can be taken into consideration during future guidance development and research priority-setting.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Lely Solari
- Instituto Nacional de Salud (INS), Ministry of Health, Lima, Peru
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
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Maritim P, Zulu JM, Jacobs C, Chola M, Chongwe G, Zyambo J, Halwindi H, Michelo C. Factors shaping the implementation of the SAFE strategy for trachoma using the Consolidated Framework for Implementation Research: a systematic review. Glob Health Action 2019; 12:1570646. [PMID: 30773102 PMCID: PMC6383623 DOI: 10.1080/16549716.2019.1570646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The SAFE strategy (surgery for trichiasis, antibiotics for active infection, facial cleanliness and environmental improvement) is the World Health Organization (WHO) recommended guideline for the elimination of blindness by trachoma by the year 2020. Objective: While evaluations on the implementation of the SAFE strategy have been done, systematic reviews on the factors that have shaped implementation are lacking. This review sought to identify these factors. Methods: We searched PUBMED, Google Scholar, CINAHL and Cochrane Collaboration to identify studies that had implemented SAFE interventions. The Consolidated Framework for Implementation Research (CFIR) guided development of the data extraction guide and data analysis. Results: One hundred and thirty-seven studies were identified and only 10 papers fulfilled the eligibility criteria. Characteristics of the innovation – such as adaptation of the SAFE interventions to suit the setting and observability of positive health outcomes from pilots – increased local adoption. Characteristics of outer setting – which included strong multisectoral collaboration – were found to enhance implementation through the provision of resources necessary for programme activities. When community needs and resources were unaccounted for there was poor compatibility with local settings. Characteristics of the inner setting – such as poor staffing, high labour turnovers and lack of ongoing training – affected health workers’ implementation behaviour. Implementation climate within provider organisations was shaped by availability of resources. Characteristics of individuals – which included low knowledge levels – affected the acceptability of SAFE programmes; however, early adopters could be used as change agents. Finally, the use of engagement strategies tailored towards promoting community participation and stakeholder involvement during the implementation process facilitated adoption process. Conclusion: We found CFIR to be a robust framework capable of identifying different implementation determinants in low resource settings. However, there is a need for more research on the organisational, provider and implementation process related factors for trachoma as most studies focused on the outer setting.
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Affiliation(s)
- Patricia Maritim
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Joseph Mumba Zulu
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Choolwe Jacobs
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Mumbi Chola
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Gershom Chongwe
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Jessy Zyambo
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Hikabasa Halwindi
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Charles Michelo
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
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Stein AT, Lang E, Migowski A. Implementing clinical guidelines: a need to follow recommendations based on the best evidence available. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180021. [DOI: 10.1590/1980-549720180021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Airton Tetelbom Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Grupo Hospitalar Conceição, Brazil
| | - Eddy Lang
- University of Calgary, Canada; Zone Clinical Department Head for Emergency Medicine in Calgary, Canada
| | - Arn Migowski
- Instituto Nacional de Cardiologia, Brazil; Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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Pallangyo E, Mbekenga C, Olsson P, Rubertsson C, Källestål C. Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania: a mixed method evaluation. Glob Health Action 2018; 10:1295697. [PMID: 28498737 PMCID: PMC5496052 DOI: 10.1080/16549716.2017.1295697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings. Objective: To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania. Methods: A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support. Results: The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers’ positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care. Conclusions: The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers’ knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance.
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Affiliation(s)
- Eunice Pallangyo
- a School of Nursing and Midwifery , Aga Khan University , Dar es Salaam , Tanzania.,b International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Columba Mbekenga
- c School of Nursing, Department of Community Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Pia Olsson
- b International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Christine Rubertsson
- b International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Carina Källestål
- b International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
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Tan J, Berg M, Gallo RL, Del Rosso JQ. Applying the phenotype approach for rosacea to practice and research. Br J Dermatol 2018; 179:741-746. [PMID: 29799114 DOI: 10.1111/bjd.16815] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Rosacea diagnosis and classification have evolved since the 2002 National Rosacea Society expert panel subtype approach. Several working groups are now aligned to a more patient-centric phenotype approach, based on an individual's presenting signs and symptoms. However, subtyping is still commonplace across the field and an integrated strategy is required to ensure widespread progression to the phenotype approach. OBJECTIVES To provide practical recommendations that facilitate adoption of a phenotype approach across the rosacea field. METHODS A review of the literature and consolidation of rosacea expert experience. RESULTS We identify challenges to implementing a phenotype approach in rosacea and offer practical recommendations to overcome them across clinical practice, interventional research, epidemiological research and basic science. CONCLUSIONS These practical recommendations are intended to indicate the next steps in the progression from subtyping to a phenotype approach in rosacea, with the goals of improving our understanding of the disease, facilitating treatment developments and ultimately improving care for patients with rosacea.
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Affiliation(s)
- J Tan
- Department of Medicine, Western University, Windsor, ON, Canada
| | - M Berg
- Department of Dermatology, Uppsala University, Uppsala, Sweden
| | - R L Gallo
- Department of Dermatology, University of California San Diego, La Jolla, CA, U.S.A
| | - J Q Del Rosso
- Department of Dermatology, Touro University Nevada, Henderson, NV, U.S.A
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Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implement Sci 2018; 13:72. [PMID: 29843737 PMCID: PMC5975671 DOI: 10.1186/s13012-018-0763-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline. This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation. ANALYSIS Recent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries. CONCLUSION Despite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.
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Affiliation(s)
- Zhicheng Wang
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
| | | | - Lisa Bero
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
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Alvarez E, Lavis JN, Brouwers M, Schwartz L. Developing a workbook to support the contextualisation of global health systems guidance: a case study identifying steps and critical factors for success in this process at WHO. Health Res Policy Syst 2018; 16:19. [PMID: 29499694 PMCID: PMC5833055 DOI: 10.1186/s12961-018-0297-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global guidance can help countries strengthen their health systems to deliver effective interventions to their populations. However, to have an impact, guidance needs to be contextualised or adapted to local settings; this process includes consideration of health system arrangements and political system factors. To date, methods to support contextualisation do not exist. In response, a workbook was designed to provide specific methods and strategies to enable the contextualisation of WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance at the national or subnational level. The objective of this study was to describe the process of developing the workbook and identify key steps of the development process, barriers that arose and facilitators that helped overcome some of these barriers. METHODS A qualitative single case study design was carried out. Interviews, documents and a reflexive journal were used. Constant comparison and an edit-style of organisation were used during data analysis to develop concepts, themes, subthemes and relationships among them. RESULTS Thirteen interviews were conducted and 52 documents were reviewed. Three main steps were identified in the process of developing the workbook for health systems guidance contextualisation, namely (1) determining the need for and gaining approval to develop the workbook, (2) developing the workbook (taking on the task, creating the structure of the workbook, operationalising its components, undergoing approval processes and editing it), and (3) implementing the workbook both at the WHO level and at the national/subnational level. Five barriers and/or facilitators emerged relevant to each step, namely (1) having well-placed and credible champions, (2) creating and capitalising on opportunities, (3) finding the right language to engage various actors and obtain buy-in, (4) obtaining and maintaining meaningful buy-in, and (5) ensuring access to resources. CONCLUSIONS Understanding the key steps and the critical factors involved in the process of developing the workbook could help in the planning of similar and other tools aimed to support the implementation of WHO guidance. A plan for dissemination and implementation needs to be addressed during the preparation of these tools.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,McMaster Health Forum, MML-417, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Juravinski Hospital Site G Wing, 2nd Floor, Room 207, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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22
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Huchko MJ, Kahn JG, Smith JS, Hiatt RA, Cohen CR, Bukusi E. Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in western Kenya. BMC Cancer 2017; 17:826. [PMID: 29207966 PMCID: PMC5717798 DOI: 10.1186/s12885-017-3818-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite guidelines for cervical cancer prevention in low-resource countries, a very small proportion of women in these settings undergo screening, and even fewer women are successfully treated. Using pilot data from western Kenya and World Health Organization recommendations, we developed a protocol to implement evidence-based cervical cancer screening and linkage to treatment strategies to the rural communities. We describe the protocol for a cluster-randomized trial to compare two implementation strategies for human-papillomavirus (HPV)-based cervical cancer screening program using metrics described in the RE-AIM (reach, efficacy, adaption, implementation and maintenance) framework. METHODS The study is a three-year, two-phase cluster-randomized trial in 18 communities in western Kenya. During Phase 1, six control communities were offered screening in health facilities; and six intervention communities were offered screening in community health campaigns. Screening was done with human-papillomavirus testing through self-collected specimens. Phase 1 ended and we are working in partnership with communities to further contextualize the implementation strategy for screening, and develop an enhanced linkage to treatment plan. This plan will be tested in an additional six communities in Phase 2 (enhanced intervention). We will compare the reach, efficacy, cost-effectiveness and adaptability of the implementation strategies. DISCUSSION Effective low-cost cervical cancer prevention technologies are becoming more widely available in low- and middle-income countries. Despite increasing government support for cervical cancer prevention, there remains a sizeable gap in service availability. We will use implementation science to identify the most effective strategies to fill this gap through development of context-specific evidence-based solutions. This protocol design and results can help guide implementation of cervical cancer screening in similar settings, where women are most underserved and at highest risk for disease. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov , NCT02124252 .
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Affiliation(s)
- Megan J Huchko
- Duke University, Global Health Institute and Department of Obstetrics and Gynecology, 310 Trent Drive, Room 204, Durham, NC, 27708, USA.
| | - James G Kahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, 2103 McGavran-Greenberg Hall Campus, Box# 7435, Chapel Hill, NC, 27599-7435, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, Box 1280, 560 Mission Street, 3rd Floor, San Francisco, CA, 94143, USA
| | - Elizabeth Bukusi
- Kenya Medical Research Institute, Center for Microbiology Research, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Nairobi, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
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Eslava-Schmalbach J, Mosquera P, Alzate JP, Pottie K, Welch V, Akl EA, Jull J, Lang E, Katikireddi SV, Morton R, Thabane L, Shea B, Stein AT, Singh J, Florez ID, Guyatt G, Schünemann H, Tugwell P. Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach. Health Policy Plan 2017; 32:1484-1490. [PMID: 29029068 PMCID: PMC5886248 DOI: 10.1093/heapol/czx126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation.
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Affiliation(s)
- Javier Eslava-Schmalbach
- Equity-in-Health Group, Faculty of Medicine, Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Cra 30 45-03, University Campus, Bogota, Colombia
- Technology Development Centre, Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), Carrera 15A 120-74, Bogota, Colombia
| | - Paola Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Juan Pablo Alzate
- Equity-in-Health Group, Clinical Research Institute, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Kevin Pottie
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Room 312, Ottawa, ON K1R 7G5, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Room 312, Ottawa, ON K1R 7G5, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Elie A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology Unit, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107, 2020 Lebanon
| | - Janet Jull
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Room 312, Ottawa, ON K1R 7G5, Canada
| | - Eddy Lang
- Department of Emergency Medicine, Foothills Medical Centre, Calgary, AB, Canada
| | | | - Rachel Morton
- Sydney School of Public Health, The University of Sydney, Sydney 2006 NSW, Australia
| | | | - Bev Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Airton T Stein
- Public Health Ufcspa, Ulbra, HTA of Conceicao Hospital, Porto Alegre, Brazil
| | - Jasvinder Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA
- Division of Epidemiology, Department of Medicine, School of Medicine, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Orthopedic Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Ivan D Florez
- Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Holger Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Department of Medicine, University of Ottawa, Ottawa, Canada
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Norris SL, Ford N. Improving the quality of WHO guidelines over the last decade: progress and challenges. LANCET GLOBAL HEALTH 2017; 5:e855-e856. [DOI: 10.1016/s2214-109x(17)30253-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
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Kabra R, Ali M, Kiarie J. Design and initial implementation of the WHO FP umbrella project- to strengthen contraceptive services in the sub Saharan Africa. Reprod Health 2017; 14:74. [PMID: 28619067 PMCID: PMC5472894 DOI: 10.1186/s12978-017-0335-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Strengthening contraceptive services in sub Saharan Africa is critical to achieve the FP 2020 goal of enabling 120 million more women and girls to access and use contraceptives by 2020 and the Sustainable Development Goals (SDG) targets of universal access to sexual and reproductive health (SRH) services including family planning by 2030. Method The World Health Organization (WHO) and partners have designed a multifaceted project to strengthen health systems to reduce the unmet need of contraceptive and family planning services in sub Saharan Africa. The plan leverages global, regional and national partnerships to facilitate and increase the use of evidence based WHO guidelines with a specific focus on postpartum family planning. The four key approaches undertaken are i) making WHO Guidelines adaptable & appropriate for country use ii) building capacity of WHO regional/country staff iii) providing technical support to countries and iv) strengthening partnerships for introduction and implementation of WHO guidelines. This paper describes the project design and elaborates the multifaceted approaches required in initial implementation to strengthen contraceptive services. Conclusion The initial results from this project reflect that simultaneous application these approaches may strengthen contraceptive services in Sub Saharan Africa and ensure sustainability of the efforts. The lessons learned may be used to scale up and expand services in other countries.
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Affiliation(s)
- Rita Kabra
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organisation, Avenue Appia 20, 1211, Geneva, Switzerland. .,, 22 chemin Henry Wissner, 1212, Grand Lancy, Geneva, Switzerland.
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
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Dedios MC, Esperato A, De-Regil LM, Peña-Rosas JP, Norris SL. Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation. Implement Sci 2017; 12:39. [PMID: 28327198 PMCID: PMC5361729 DOI: 10.1186/s13012-017-0571-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO. METHODS We used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7). RESULTS The nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups. CONCLUSIONS Overall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.
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Affiliation(s)
| | | | - Luz Maria De-Regil
- Evidence and Program Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Juan Pablo Peña-Rosas
- Evidence and Program Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Susan L. Norris
- Guideline Review Committee Secretariat, World Health Organization, Geneva, Switzerland
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Chen MJ, Kim CR, Whitehouse KC, Berry-Bibee E, Gaffield ME. Development, updates, and future directions of the World Health Organization Selected Practice Recommendations for Contraceptive Use. Int J Gynaecol Obstet 2016; 136:113-119. [PMID: 28099730 PMCID: PMC6546088 DOI: 10.1002/ijgo.12064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Caron R Kim
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Katherine C Whitehouse
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Erin Berry-Bibee
- Division of Reproductive Health, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Mary E Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Vogel JP, Moore JE, Timmings C, Khan S, Khan DN, Defar A, Hadush A, Minwyelet Terefe M, Teshome L, Ba-Thike K, Than KK, Makuwani A, Mbaruku G, Mrisho M, Mugerwa KY, Puchalski Ritchie LM, Rashid S, Straus SE, Gülmezoglu AM. Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity. PLoS One 2016; 11:e0160020. [PMID: 27806041 PMCID: PMC5091885 DOI: 10.1371/journal.pone.0160020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/12/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO's Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael's Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. METHODS We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). RESULTS Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. CONCLUSION This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.
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Affiliation(s)
- Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, Geneva, Switzerland
| | - Julia E. Moore
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Caitlyn Timmings
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sobia Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Dina N. Khan
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, Geneva, Switzerland
| | - Atkure Defar
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Kyu Kyu Than
- Burnet Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Makuwani
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar-es-Salaam, United Republic of Tanzania
| | - Godfrey Mbaruku
- Ifakara Health Institute, Dar-es-Salaam, United Republic of Tanzania
| | - Mwifadhi Mrisho
- Ifakara Health Institute, Dar-es-Salaam, United Republic of Tanzania
| | | | - Lisa M. Puchalski Ritchie
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Canada
| | - Shusmita Rashid
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - A. Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, Geneva, Switzerland
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