Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa
| Autor: | Jocelyn Muller, Jimmy Volmink, Tamara Kredo, Salla Atkins, Amber Abrams, Sara Cooper |
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| Přispěvatelé: | Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences, University of Tampere |
| Rok vydání: | 2018 |
| Předmět: |
Health Knowledge
Attitudes Practice Kansanterveystiede ympäristö ja työterveys - Public health care science environmental and occupational health Health Personnel Allied Health Personnel Rural Health Theoretical domains framework Health informatics Health administration 03 medical and health sciences South Africa 0302 clinical medicine Qualitative research Health care Medicine Humans 030212 general & internal medicine Medical education Motivation Primary Care Nursing Primary Health Care business.industry lcsh:Public aspects of medicine 030503 health policy & services Health Policy Nursing research Behavior change Behaviour change lcsh:RA1-1270 Professional Practice Guideline Focus Groups Primary care Focus group Quality Improvement Implementation Practice Guidelines as Topic Guideline Adherence Thematic analysis 0305 other medical science business Clinical practice guidelines Delivery of Health Care Research Article |
| Zdroj: | BMC Health Services Research BMC Health Services Research, Vol 18, Iss 1, Pp 1-12 (2018) |
| ISSN: | 1472-6963 |
| Popis: | Background Clinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified. Methods We used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions. Results Participants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency. Conclusions South African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa. Electronic supplementary material The online version of this article (10.1186/s12913-018-3778-2) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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