Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles

Abstract

IntroductionThe COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs).MethodsWe used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt.ResultsWe describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.ConclusionsGuideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.

Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic

“…Community-based health actors' narratives point to the value of an organizational culture of care, which was integral to actors' confidence amid the early stages of the COVID-19 pandemic. Organizational-level care practices, such as implementing tangible infection control measures, helped to mitigate fears among community-based health actors, as well as fears within communities directed toward these actors ( Haldane et al, 2021b ). Moreover, those respondents in supervisory roles expressed fear for the safety of staff for whom they were responsible; yet, they channeled this fear into tangible expressions of care that assuaged some fears of staff.…”

“…Once the initial wave of COVID-19 case numbers decreased in communities where they work, the program resumed. ICM, in collaboration with researchers from the University of Toronto (Canada) and University of Waterloo (Canada), co-developed COVID-19 guidelines ( Haldane et al, 2021b ). These guidelines, in addition to ICM's own organizational protocols, included the use of personal protective equipment (PPE), infection prevention and control training, and also required staff to adhere to local public health restrictions in their respective jurisdictions.…”

Exploring the translation process for multilingual implementation research studies: a collaborative autoethnography

“…This included active discussion of the foreign gaze and interpretation of meaning, in the condensation, categorisation and creation of the cohesive master narrative from the interviews. 16 All team members reviewed and provided candid feedback that added depth of experience to the curated master narrative. Once the master narrative was finalised, two team members (VH and BPL) analysed the data thematically.…”

We go farther together: practical steps towards conducting a collaborative autoethnographic study

“…The ongoing pandemic offers an important opportunity for teams to conduct autoethno-graphic work to reflect on the dynamic challenges to research and implementation 7 . For example, a recent collaborative autoethnography by multidisciplinary researchers and clinicians from four countries explored development of infection prevention and control (IPC) guidelines for coronavirus disease 2019 (COVID-19) pandemic management 8 . Autoethnography, in particular, collaborative autoethnography, can yield important insights into the research process and should be an important component of any implementation science researcher's tool kit.…”

“…7 For example, a recent collaborative autoethnography by multidisciplinary researchers and clinicians from four countries explored development of infection prevention and control (IPC) guidelines for coronavirus disease 2019 (COVID-19) pandemic management. 8 Autoethnography, in particular, collaborative autoethnography, can yield important insights into the research process and should be an important component of any implementation science researcher's tool kit. Here we offer an outline of practical steps for such researchers embarking on a collaborative autoethnography.…”