Factors hindering the adherence to clinical practice guideline for diabetes mellitus in the Palestinian primary healthcare clinics: a qualitative study

Abstract

ObjectiveDespite a high number of the internationally produced and implemented clinical guidelines, the adherence with them is still low in healthcare. This study aimed at exploring the perspectives and experiences of senior doctors and nurses towards the barriers of adherence to diabetes guideline.SettingThe Palestinian Primary Health Care-Ministry of Health (PHC-MoH) and Primary Health Care-United Nations Relief and Works Agency for Palestine Refugees in the Near East (PHC- UNRWA) in Gaza Strip.ParticipantsIndividual face-to-face in-depth interviews were conducted with 20 senior doctors and nurses who were purposefully selected.MethodsQualitative design was employed using the theoretical framework by Cabana et al to develop an interview guide. Semi-structural and audio-recorded interviews were conducted. Data were transcribed verbatim and thematically analysed.ResultsThe key theme barriers identified by participants that emerged from the analysed data were in regard of the PHC-MoH lack reimbursement, lack of resources and lack of the guideline trustworthiness, and in regard of PHC-UNRWA the time constraints and the lack of the guideline trustworthiness. The two key subthemes elicited from the qualitative analysis were the outdated guideline and lack of auditing and feedback.ConclusionThe analysis identified a wide range of barriers against the adherence to diabetes guideline within the PHC-MoH and PHC-UNRWA. The environmental-related and guideline-related barriers were the most prominent factors influencing the guideline adherence. Our study can inform the policy makers and senior managers to develop a tailored interventions that can target the elicited barriers through a multifaceted implementation strategy.

Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review

“…The included studies described the methods of data collection adequately. For instance, two studies presented the topic guides as Supplementary Materials [ 14 , 19 ], one adequately described the topic guide content [ 16 ], one described the method used to build the topic guide [ 15 ], and four discussed the saturation of data [ 16 , 17 , 18 , 19 ]. Analysis was conducted using a thematic framework [ 17 , 18 , 19 ], grounded theory analysis [ 16 ], and qualitative content analysis [ 14 ], whereas one study did not report the method used for analysis.…”

“…Three studies focused on identifying barriers [ 17 , 19 ] or facilitators [ 18 ] of CPG implementation. Five studies focused on measuring the clinicians’ awareness of, familiarity with, or attitude toward CPGs [ 16 , 22 , 23 , 25 , 26 ] in addition to exploring barriers and facilitators.…”

“…Table 2 presents the results of the quality assessment of the qualitative studies. The purposive snowballing sampling technique was used in four studies [16][17][18][19], whereas two studies targeted clinicians in specific hospitals [14,15]. Although the cited studies adequately described the selection of participants, no information was provided on the recruitment process, such as the original number invited and those who declined.…”

“…For instance, two studies presented the topic guides as Supplementary Materials [14,19], one adequately described the topic guide content [16], one described the method used to build the topic guide [15], and four discussed the saturation of data [16][17][18][19]. Analysis was conducted using a thematic framework [17][18][19], grounded theory analysis [16], and qualitative content analysis [14], whereas one study did not report the method used for analysis. The main concern regarding the quality of qualitative studies was that although rigorous, data analysis specifically failed to address the role of the researchers and point out potential bias during the formulation of research questions and data collection including sample recruitment and the rationale for deriving themes from the data.…”

Evaluating the Adherence to Guidelines for Management of Acute Heart Failure in the Gaza Strip Hospitals: A Medical Chart–Based Review Study

“…The barriers for better adherence to clinical guidelines in the context of Gaza can be either environment related or guideline related. [57] There are three main environment-related barriers. First, the lack of resources and fluctuating availability of diagnostic tests (such as with BNP), which often depends on what is received as donations.…”