South African clinical practice guidelines: A landscape analysis

Wilkinson, Maryke; Wilkinson, Thomas; Kredo, Tamara; MacQuilkan, Kim; Mudara, Caroline; Winch, Anne E.; Pillay, Yogan; Hofman, Karen

doi:10.7196/samj.2017.v108i1.12825

Cited by 16 publications

(16 citation statements)

References 3 publications

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“…Participants specifically suggested that outcome measures must be multi-disciplinary and holistic. This suggestion is in line with the person-centred approach current advocated by the South African Department of Health [ 22 – 24 ].…”

Section: Resultssupporting

confidence: 75%

Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

Louw

Grimmer

Dizon

et al. 2018

Health Res Policy Sys

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BackgroundThe large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building.MethodsA qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge.ResultsCapacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated.ConclusionSouth African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.

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Section: Resultssupporting

confidence: 75%

Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

Louw

Grimmer

Dizon

et al. 2018

Health Res Policy Sys

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“…Guideline quality in prehospital care was also raised as a concern, a sentiment prevalent across various disciplines, from primary health care to allied health [ 4 , 6 , 11 ]. Furthermore, a similar landscape analysis conducted of only South African guidance documents highlighted the lack of emergency care guidance available [ 12 ]. Guidance document quality seems to be a concern for LMICs, possibly due to their lack of formal guidance document organisations, technical capacity, or collaborations to develop evidence-based guidance documents [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Guidance we can trust? The status and quality of prehospital clinical guidance in sub-Saharan Africa: A scoping review

Malherbe

Smit

Sharma

et al. 2021

African Journal of Emergency Medicine

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Introduction Prehospital care is integral in addressing sub-Saharan Africa's (SSA) high injury and illness burden. Consequently, robust, high-quality prehospital guidance documents are needed to inform care. These guidance documents include, but are not limited to, clinical practice guidelines (CPGs), protocols and algorithms that are contextually appropriate for SSA. However, SSA prehospital guidance mostly originates from the ‘Global North,’ with limited guidance for Africa by Africans. To strengthen prehospital clinical practice in SSA, we described and appraised all prehospital SSA guidance documents informing clinical decision making. Methods We conducted a scoping review of prehospital-relevant guidance documents, including CPGs, algorithms, protocols and position statements originating from SSA. We performed a comprehensive literature search in various databases (PUBMED and SCOPUS), guideline clearing houses (Scottish Intercollegiate Guidelines Network, Trip, and Guidelines International Network), journals, various forms of grey literature and contacted experts. Guidance document screening and data extraction was done independently, in duplicate and reviewed by a third author. Guidance quality was then determined using the AGREE II tool and data were analysed using simple descriptive statistics. Results We included 51 guidance documents from 13 countries across SSA after screening 2320 potential documents. The majority of guidance documents lacked an evidence foundation, made recommendations based on expert input, and were predominantly end-user presentations such as algorithms or protocols. Overall, reporting quality was poor, specifically for critical domains such as rigour of development; however, clarity of presentation was generally strong. Guidance topics were focused around resuscitation and common diseases (both communicable and non-communicable) with major gaps identified across a variety of topics; such as mental health for example. Conclusion The majority of prehospital clinical guidance from SSA provides clinicians with excellent ready to use end-user material. Conversely, most of the guidance documents lack an appropriate evidence foundation and fail to transparently report the guidance development process, highlighting the need to strengthen and build guideline development capacity to promote the transition from eminence-based to evidence-based guidance for prehospital care in SSA. Guideline developers, professional societies and publishers need to be aware of international and local guidance document development and reporting standards in order to produce guidance we can trust.

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“…South Africa has long been developing CPGs, most pronounced during the post-apartheid period when CPGs were considered important tools to redress inequity, standardise care and promote cost-effective care for all. Many CPG development players have been identified: national government, professional societies, hospitals and clinics all contribute according to their needs and agendas [6, 7]. However, despite development and distribution of CPGs, health outcomes remain poor, and generally worse than expected given the per capita health spend relative to other similar middle-income countries [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa

Kredo

Cooper

Abrams

et al. 2018

BMC Health Serv Res

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BackgroundClinical 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.MethodsWe 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.ResultsParticipants 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.ConclusionsSouth 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 materialThe online version of this article (10.1186/s12913-018-3778-2) contains supplementary material, which is available to authorized users.

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South African clinical practice guidelines: A landscape analysis

Cited by 16 publications

References 3 publications

Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

Guidance we can trust? The status and quality of prehospital clinical guidance in sub-Saharan Africa: A scoping review

Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa

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