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Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study

dc.contributor.authorMcCaul, Michaelen_ZA
dc.contributor.authorYoung, Tarynen_ZA
dc.contributor.authorBruijns, Stevan R.en_ZA
dc.contributor.authorClarke, Mikeen_ZA
dc.date.accessioned2020-05-28T20:45:03Z
dc.date.available2020-05-28T20:45:03Z
dc.date.issued2020
dc.identifier.citationMcCaul, M., et al. 2020. Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study. BMC Health Services Research, 20:349, doi:10.1186/s12913-020-05111-x
dc.identifier.issn1472-6963 (online)
dc.identifier.otherdoi:10.1186/s12913-020-05111-x
dc.identifier.urihttp://hdl.handle.net/10019.1/108617
dc.descriptionCITATION: McCaul, M., et al. 2020. Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study. BMC Health Services Research, 20:349, doi:10.1186/s12913-020-05111-x.
dc.descriptionThe original publication is available at https://bmchealthservres.biomedcentral.com
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund
dc.description.abstractBackground: Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG adaptation) — a specific issue for guideline development groups in low- and middle-income countries — is sparse. There are only a few examples showcasing the pragmatic application of such alternative approaches in settings with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen the methods of developing prehospital CPGs using alternative guideline development methods through a case study design. Methods: We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points. Results: Key challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions. Conclusion: The cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.en_ZA
dc.description.urihttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05111-x
dc.format.extent12 pages illustration
dc.language.isoen_ZAen_ZA
dc.publisherBMC (part of Springer Nature)
dc.subjectAmbulatory medical care -- Practiceen_ZA
dc.subjectEmergency medical services -- Practiceen_ZA
dc.subjectClinical medicine -- Practiceen_ZA
dc.subjectMedical protocols -- South Africaen_ZA
dc.titleStrengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case studyen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright


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