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Koc EM, Aksoy H, Ayhan Baser D, Baydar Artantas A, Kahveci R, Cihan FG. Evaluation of clinical practice guideline quality: comparison of two appraisal tools. Int J Qual Health Care 2020; 32:663-670. [DOI: 10.1093/intqhc/mzaa129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The tools used for critically appraising the quality of clinical practice guidelines are complex and not suitable for the busy end users. So rapid, effective and simple instruments are more preferred. The aim of this study is to compare two critical appraisal tools: iCAHE as a rapid instrument and AGREE II as a complex instrument on guideline quality assessment.
Material and Methods
The diabetes mellitus guidelines of the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Clinical Excellence (NICE), the International Diabetes Federation (IDF) and the Society of Endocrinology and Metabolism of Turkey (SEMT) were assessed separately by four appraisers using the iCAHE and AGREE II instruments. The mean iCAHE criteria scores and the total and domain AGREE II scores given by the four appraisers are presented for each guideline.
Results
No statistically significant difference was detected between the iCAHE scale scores of the guidelines evaluated (P = 0.063). The rank of the guidelines according to their average total iCAHE and AGREE II instrument scores was similar. The iCAHE mean scores of the guidelines were as follows: NICE, 92.85%; SIGN, 92.85%; IDF, 66.07% and SEMT, 73.21%. The AGREE II mean scores of the guidelines were as follows: NICE, 87.13%; SIGN, 78.25%; IDF, 53.44% and SEMT, 53.22%.
Conclusions
In addition to being a quality scale, the iCAHE checklist is easy, practical and short to implement. It also helps the users to understand the quality of the guideline in a shorter time. To increase the use of guidelines, it is important that users with little experience and time use the iCAHE scale as a rapid appraisal tool, but more studies are needed to decide the best appraisal tool.
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Affiliation(s)
- Esra Meltem Koc
- Katip Celebi University Faculty of Medicine, Department of Family Medicine, Izmir, Turkey
| | - Hilal Aksoy
- Hacettepe University Faculty of Medicine, Department of Family Medicine, Ankara, 06230, Turkey
| | - Duygu Ayhan Baser
- Hacettepe University Faculty of Medicine, Department of Family Medicine, Ankara, 06230, Turkey
| | - Aylin Baydar Artantas
- University of Health Sciences Ankara Bilkent City Hospital, Department of Family Medicine, Ankara, Turkey
| | - Rabia Kahveci
- Health Technology Assessment Department, Ukraine Ministry of Health, Kiev Region, Ukraine
| | - Fatma Goksin Cihan
- Necmettin Erbakan University, Faculty of Medicine, Department of Family Medicine, Konya, Turkey
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Young T, Dizon J, Kredo T, McCaul M, Ochodo E, Grimmer K, Louw Q. Enhancing capacity for clinical practice guidelines in South Africa. Pan Afr Med J 2020; 36:18. [PMID: 32774595 PMCID: PMC7388621 DOI: 10.11604/pamj.2020.36.18.20800] [Citation(s) in RCA: 1] [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] [Received: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Use of good quality, evidence-informed and up-to-date clinical practice guidelines (CPGs) has the potential to impact health outcomes. This paper describes the development, implementation and evaluation of a dedicated CPG training course to address the training needs of CPG stakeholders in South Africa. METHODS We first reviewed the content and teaching strategies of existing CPG courses. This review consisted of a systematic review of teaching and learning strategies for guideline teams and a document review of existing courses offered by international guideline groups, universities and professional groups. We then strengthened an existing CPG course and evaluated it. RESULTS We found no studies on teaching and learning strategies for guideline teams. We identified six CPG courses being offered as full courses (part of a postgraduate degree program) by universities or as independent training for continuing professional education by professional groups. Contents focused on new guideline development. One course included alternative methods of guideline approaches such as contextualization and adaptation. The format varied from face-to-face sessions, to online sessions, group exercises and discussions, seminar format and project based activities. The revised CPG four-month long course that we implemented was designed to be pragmatic, reflective and contextually relevant. It used local guideline examples, authentic tasks, and an online forum for discussions and resources. It covered de novo CPG development, alternative methods of development (adopting, contextualising, adapting), and implementing CPGs. Course evaluation identified strengths and areas for improvement. CONCLUSION Dedicated capacity development has potential to positively influence CPG development and implementation.
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Affiliation(s)
- Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Janine Dizon
- International Centre for Allied Health Evidence (iCAHE), City East Campus, P4-18 North Terrace, University of South Australia, Adelaide 5000, Australia
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Eleanor Ochodo
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Karen Grimmer
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Clinical Education and Training, VITA, Flinders University, Bedford Park, Adelaide, SA 5042
| | - Quinette Louw
- Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Trajanovska M, King S, Goldfeld S, Gibb S. A novel method of rapid appraisal of clinical practice guidelines for children with enuresis. J Pediatr Urol 2019; 15:333.e1-333.e9. [PMID: 31217085 DOI: 10.1016/j.jpurol.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Enuresis (bedwetting) is a common but variably managed pediatric condition. Despite an abundance of published documents which provide recommendations for clinical evaluation and management of enuresis, no formal appraisal of their methodological quality has been undertaken. OBJECTIVE The objective of the study is to evaluate the quality of current pediatric guidelines for enuresis (bedwetting) using a novel method of appraisal. STUDY DESIGN A comprehensive gray literature search was undertaken to identify guideline documents that provided recommendations for management of enuresis in children and adolescents. The search strategy included guideline databases, targeted websites, Google search engines, and MEDLINE. Guideline documents included clinical practice guidelines, consensus documents, position statements, and other clinical review documents. Each document underwent basic appraisal by two independent assessors using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist. Those documents which (1) had an iCAHE quality score of ≥10; (2) used a systematic search strategy; and (3) linked evidence to their recommendations underwent further detailed appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS Eighteen documents were shortlisted for basic appraisal. The iCAHE highlighted a lack of information regarding underlying evidence and dates (mean score 36% and 41%, respectively). Only three documents met basic quality criteria and progressed to detailed appraisal using the AGREE II. These included guidelines produced by the Paediatric Society of New Zealand and National Clinical Guideline Centre and a position statement from the Canadian Paediatric Society. All three guidelines presented clear and unambiguous recommendations (mean score 80%). However, information regarding stakeholder involvement was lacking (mean score 50%). CONCLUSIONS Several guidelines exist for the evaluation and management of children with enuresis, but many lack appropriate methodological quality standards. The guideline produced by the National Clinical Guideline Centre achieved the highest quality rating and is recommended for future adaptation and implementation in relevant clinical settings.
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Affiliation(s)
- M Trajanovska
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia 3052
| | - S King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - S Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia 3052; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 3052, Australia; Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - S Gibb
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia; Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, 3052, Australia.
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Okwen PM, Maweu I, Grimmer K, Margarita Dizon J. Evaluation of all African clinical practice guidelines for hypertension: Quality and opportunities for improvement. J Eval Clin Pract 2019; 25:565-574. [PMID: 29901241 DOI: 10.1111/jep.12954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Good-quality clinical practice guidelines (CPGs) provide recommendations based on current best-evidence summaries. Hypertension is a prevalent noncommunicable disease in Africa, with disastrous sequelae (stroke, heart, and kidney disease). Its effective management relies on good quality, current, locally relevant evidence. This paper reports on an all African review of the guidance documents currently informing hypertension management. METHODS Attempts were made to contact 62 African countries for formal guidance documents used nationally to inform diagnosis and management of hypertension. Their quality was assessed by using Appraisal of Guidelines for Research & Evaluation (AGREE) II, scored by 2 independent reviewers. Differences in domain scores were compared between documents written prior to 2011 and 2011 onward. Findings were compared with earlier African CPG reviews. RESULTS Guidelines and protocols were provided by 26 countries. Six used country-specific stand-alone hypertension guidelines, and 10 used protocols embedded in Standard Treatment Guidelines for multiple conditions. Six used guidelines developed by the World Health Organization, and 4 indicated ad hoc use of international guidance (US, Portugal, and Brazil). Only 1 guidance document met CPG construction criteria, and none scored well on all AGREE domain scores. The lowest-scoring domain was rigour of development. There was no significant quality difference between pre-2011 and post-2011 guidance documents, and there were variable AGREE II scores for the same CPGs when comparing the African reviews. CONCLUSIONS The quality of hypertension guidance used by African nations could be improved. The need for so many guidance documents is questioned. Adopting a common evidence base from international good-quality CPGs and layering it with local contexts offer 1 way to efficiently improve African hypertension CPG quality and implementation.
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Affiliation(s)
- Patrick Mbah Okwen
- Effective Basic Services for Africa (eBASE), Bamenda, Cameroon.,Centre for Development of Best Practices for Health, Yaounde, Cameroon
| | | | - Karen Grimmer
- Dept Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janine Margarita Dizon
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
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Vähäniemi A, Välimäki M, Pekurinen V, Anttila M, Lantta T. Quality and utilization of the Finnish clinical practice guideline in schizophrenia: evaluation using AGREE II and the vignette approach. Neuropsychiatr Dis Treat 2019; 15:1239-1248. [PMID: 31190830 PMCID: PMC6512783 DOI: 10.2147/ndt.s192752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aims to evaluate the quality of the Finnish clinical practice guideline related to schizophrenia care and how it can be utilized in psychiatric services. PARTICIPANTS AND METHODS The data were collected from one psychiatric ward and seven psychiatric outpatient units situated in two cities in Southern Finland. A total of 49 professionals working in these sites participated in this study. A descriptive study design was adopted. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument with six domains including 23 items was used to assess the quality of the guideline, whereas a vignette was implemented to describe how staff would use the guideline in hypothetical cases in daily practice. The analysis of AGREE II was based on rating each of the 23 items on a seven-point scale and calculating a quality score for the six domains. To describe the utilization of the guideline, eight key recommendations of the guideline were deductively rated out of the respondents' answers. RESULTS The results showed that the "scope and purpose" of the guideline were well described, but "applicability" was insufficient. The overall quality of the guideline was high (73%). Almost one fifth of the respondents were in agreement with key recommendations. CONCLUSION The overall quality of Guideline for Schizophrenia was good, but its "applicability" and utilization should be improved.
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Affiliation(s)
- Anu Vähäniemi
- Department of Nursing Science, University of Turku, Turku, Finland, .,Mental Health and Substance Abuse Services, City of Tampere, Tampere, Finland,
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland, .,Turku University Hospital, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Virve Pekurinen
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland,
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Kredo T, Cooper S, Abrams A, Daniels K, Volmink J, Atkins S. National stakeholders' perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Res Policy Syst 2018; 16:68. [PMID: 30064440 PMCID: PMC6069850 DOI: 10.1186/s12961-018-0348-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
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Affiliation(s)
- Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Amber Abrams
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jimmy Volmink
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Deans Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,New Social Research and Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Dizon JM, Grimmer KA, Machingaidze S, Louw QA, Parker H. South African primary health care allied health clinical practice guidelines: the big picture. BMC Health Serv Res 2018; 18:48. [PMID: 29378586 PMCID: PMC5789688 DOI: 10.1186/s12913-018-2837-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 01/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Good quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care. This paper reports on the current 'state of play' of CPGs in a lower-to-middle-income country (South Africa), where primary healthcare (PHC) AH activities face significant challenges in terms of ensuring quality service delivery in the face of huge PHC need. METHODS A qualitative study was conducted, using semi-structured interviews with purposively-sampled individuals involved in AH PHC CPGs in South Africa. They included national and state government policy-makers, academics and educators, service managers, clinicians, representatives of professional associations, technical writers, and members of informal professional networks. The interview data was transcribed and de-identified, and analysed descriptively by hand-coding. The COREQ statement guided study conduct and reporting. A framework to guide research in other countries into perspectives of AH PHC CPG activities was established. RESULTS Of the 32 invited, 29 people participated: of these 25 were interviewed and four provided meeting notes. Most participants had multiple professional roles, being engaged concurrently in clinical practice, academia, professional associations and / or government. Key themes comprised Players (sub-themes of sampling frame, participants, advice, role players and collaboration); Guidance (sub-themes of nomenclature, drivers, purpose, evidence sources) and Role of AH in PHC (sub-themes of discipline groupings, disability and rehabilitation, AH recognition). CONCLUSION There was consistently-expressed desire for quality guidance to support better quality AH PHC activities around the country. However no international CPGs were used, and there were no South African CPGs specific to local PHC AH practice. The guidance gap was filled by non-evidence-based documents produced often without training, to deal with specific clinical situations. This led to frustration, duplication and fragmentation of effort, confusing nomenclature, and an urgent need for standardised and agreed guidance. We provided a standardised framework to capture perspectives on CPGs activities in other AH PHC settings.
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Affiliation(s)
- J. M. Dizon
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, 5000 Australia
- Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - K. A. Grimmer
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - S. Machingaidze
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
| | - Q. A. Louw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - H. Parker
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
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8
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Dizon JM, Grimmer K, Louw Q, Machingaidze S, Parker H, Pillen H. Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study. Health Res Policy Syst 2017; 15:79. [PMID: 28915890 PMCID: PMC5603069 DOI: 10.1186/s12961-017-0243-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
Background The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC. Methods Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes. Results CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice. Conclusion CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.
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Affiliation(s)
- J M Dizon
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia. .,Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa.
| | - K Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia.,Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - Q Louw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - S Machingaidze
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7505, Cape Town, South Africa.,European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, 7505, Cape Town, South Africa
| | - H Parker
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - H Pillen
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia
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9
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Okwen PM. Evidence implementation in lower- and middle-income countries: where the recipe is incomplete. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2227-2228. [PMID: 28902687 DOI: 10.11124/jbisrir-2017-003559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Patrick M Okwen
- Medical Doctor, Effective Basic Services, Bali District Hospital, Bamenda, Cameroon
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10
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Cooper M, McCutcheon H, Warland J. A critical analysis of Australian policies and guidelines for water immersion during labour and birth. Women Birth 2017; 30:431-441. [PMID: 28529087 DOI: 10.1016/j.wombi.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/10/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Accessibility of water immersion for labour and/or birth is often dependent on the care provider and also the policies/guidelines that underpin practice. With little high quality research about the safety and practicality of water immersion, particularly for birth, policies/guidelines informing the practice may lack the evidence necessary to ensure practitioner confidence surrounding the option thereby limiting accessibility and women's autonomy. AIM The aims of the study were to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/guideline facilitates the option for labour and birth. METHOD Phase one of a three-phase mixed-methods study critically analysed 25 Australian water immersion policies/guidelines using critical discourse analysis. FINDINGS Policies/guidelines pertaining to the practice of water immersion reflect subjective opinions and views of the current literature base in favour of the risk-focused obstetric and biomedical discursive practices. Written with hegemonic influence, policies and guidelines impact on the autonomy of both women and practitioners. CONCLUSION Policies and guidelines pertaining to water immersion, particularly for birth reflect opinion and varied interpretations of the current literature base. A degree of hegemonic influence was noted prompting recommendations for future maternity care policy and guidelines'. ETHICAL CONSIDERATIONS The Human Research Ethics Committee of the University of South Australia approved the research.
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Affiliation(s)
- Megan Cooper
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia.
| | - Helen McCutcheon
- Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia
| | - Jane Warland
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia
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