Browsing by Author "Ernstzen, Dawn"
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- ItemClinical practice guideline adaptation methods in resource-constrained settings : four case studies from South Africa(BMJ Publishing, 2020-12) McCaul, Michael; Ernstzen, Dawn; Temmingh, Henk; Draper, Beverly; Galloway, Michelle; Kredo, TamaraDeveloping a clinical practice guideline (CPG) is expensive and time-consuming and therefore often unrealistic in settings with limited funding or resources. Although CPGs form the cornerstone of providing synthesised, systematic, evidence-based guidance to patients, healthcare practitioners and managers, there is no added benefit in developing new CPGs when there are accessible, good-quality, up-to-date CPGs available that can be adapted to fit local needs. Different approaches to CPG development have been proposed, including adopting, adapting or contextualising existing high-quality CPGs to make recommendations relevant to local contexts. These approaches are attractive where technical and financial resources are limited and high-quality guidance already exists. However, few examples exist to showcase such alternative approaches to CPG development. The South African Guidelines Excellence project held a workshop in 2017 to provide an opportunity for dialogue regarding different approaches to guideline development with key examples and case studies from the South African setting. Four CPGs represented the topics: mental health, health promotion, chronic musculoskeletal pain and prehospital emergency care. Each CPG used a different approach, however, using transparent, reportable methods. They included advisory groups with representation from content experts, CPG users and methodologists. They assessed CPGs and systematic reviews for adopting or adapting. Each team considered local context issues through qualitative research or stakeholder engagement. Lessons learnt include that South Africa needs fit-for-purpose guidelines and that existing appropriate, high-quality guidelines must be taken into account. Approaches for adapting guidelines are not clear globally and there are lessons to be learnt from existing descriptions of approaches from South Africa.
- ItemPatient perspectives about the healthcare of chronic musculoskeletal pain : three patient cases(AOSIS Publishing, 2016-05) Ernstzen, Dawn; Louw, Quinette; Hillier, SusanBackground: Consideration of the patient’s perspective in healthcare is important because it may inform holistic and contextually relevant management strategies. Objectives: The purpose of this study was to explore patients’ experiences and perspectives about their chronic musculoskeletal (CMSK) pain and its management in the private healthcare sector in South Africa. This work was done as a pilot study to test, adapt and finalize an interview schedule. Methods: A descriptive, qualitative study was conducted. The sampling was purposive. Three patients with CMSK pain were recruited to participate in in-depth individual interviews. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analyses of the transcripts were undertaken. Initial codes were assigned and a code book developed, which was applied to the transcripts to develop categories and themes. Results: Four themes emerged from the data: (1) the participants sought understanding about the pain’s origin and the reason for pain persistence; (2) pain impacted their lives in multiple ways; (3) the participants depended on healthcare providers (HCP) for guidance and support; and (4) they had the option of acceptance of chronic pain. Conclusion: The participants’ knowledge about their health condition had important implications as it influenced their perspectives on pain and its management. The pain presented the participants with several challenges, which included developing an understanding about pain and coping with the impact of pain in their lives. HCPs were perceived to play an important role in empowering or disempowering the participants.
- ItemPhysiotherapy students’ perceptions of the dual role of the clinical educator as mentor and assessor : influence on the teaching–learning relationship(AOSIS Publishing, 2017) Meyer, Ilse S.; Louw, Alwyn; Ernstzen, DawnBackground: Clinical education is widely considered to be the cornerstone of health care professionals’ education. Clinical educators (CEs) fulfil many roles and act as both mentors and assessors in the learning process of students’ undergraduate health care professions education. However, changing from being a mentor to being an assessor may present particular challenges for both the CE and the students. Objective: To explore students’ perceptions of how the dual role of a CE as mentor and assessor influenced the teaching–learning (T-L) relationship. Method: A qualitative descriptive study, involving seven individual semi-structured interviews and two focus group discussions, was conducted with students in the Division of Physiotherapy, Stellenbosch University. A contextualised interpretive content analysis was used to analyse the data. By following an iterative process, themes were identified and categories were reviewed and refined. Results: Challenges were experienced when CEs had to act and change as both mentors and assessors to the needs of the students. This influenced the T-L relationship and consequently impacted the learning of students. The expectations of students and CEs were often not fulfilled. Contradictions were disclosed regarding the dual role of CEs. Conclusion: The findings of the study, grounded in the perceptions and experiences of students on the dual role of the CE, are highlighted. It is important to consider the challenges that the students face in order to minimise any negative effects these challenges could have on students’ learning processes.
- ItemA South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines(BMC (part of Springer Nature), 2019-06-06) Grimmer, Karen; Louw, Quinette; Dizon, Janine M.; Brown, Sjan-Mari; Ernstzen, Dawn; Wiysonge, Charles S.Background: Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach. Methods: Composite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence. Findings: The structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers. Conclusion: The South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice.
- ItemA systematic review on self-management education campaigns for back pain(AOSIS, 2019) Nkhata, Loveness A.; Brink, Yolandi; Ernstzen, Dawn; Louw, Quinette A.Background: Evidence-based clinical practice guidelines on back pain recommend early management and use of approaches that emphasise self-management, psychological and physical therapies. Lately, mass media campaigns, addressing misconceptions about back pain, have been conducted in developed countries. Objectives: This study retrieved and synthesised the contents of back pain messages and described the outcomes and effectiveness of the media campaigns. Method: Seventeen key words and 10 electronic databases were used to conduct a search between February and July 2018. Authors screened titles, abstracts and full-text articles independently to identify eligible studies. Data were reported using narratives because of heterogeneity in the outcomes. Results: Appraisal of articles was done using the Physiotherapy Evidence Database scale for randomised controlled trials (RCT) (one) or the Joanna Briggs Institute checklist for non-RCT (four). The campaigns were conducted in the general population in Australia, Canada, Norway, the Netherlands and Scotland. The message ‘stay as active as possible’ increased participants’ awareness and influenced their health beliefs and healthcare utilisation behaviours resulting in reductions in sick leave days, work disability, healthcare utilisation and claims. Conclusion: The back pain campaign message ‘stay as active as possible’ increased participants’ awareness and influenced their health beliefs and healthcare utilisation behaviours. Even though the campaigns were done in high-income countries, their contents and methods are transferable to developing countries. However, their implementation must be tailored and efficient and cost-effective methods need to be explored.