Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa
Abstract 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 ca...
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3778-2 |
| _version_ | 1819241834100031488 |
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| author | Tamara Kredo Sara Cooper Amber Abrams Jocelyn Muller Jimmy Volmink Salla Atkins |
| author_facet | Tamara Kredo Sara Cooper Amber Abrams Jocelyn Muller Jimmy Volmink Salla Atkins |
| author_sort | Tamara Kredo |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-23T14:30:12Z |
| format | Article |
| id | doaj.art-5154cd0aa6eb4e31bb6555167049ff08 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-23T14:30:12Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-5154cd0aa6eb4e31bb6555167049ff082022-12-21T17:43:32ZengBMCBMC Health Services Research1472-69632018-12-0118111210.1186/s12913-018-3778-2Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South AfricaTamara Kredo0Sara Cooper1Amber Abrams2Jocelyn Muller3Jimmy Volmink4Salla Atkins5Cochrane South Africa, South African Medical Research CouncilCochrane South Africa, South African Medical Research CouncilCochrane South Africa, South African Medical Research CouncilCochrane South Africa, South African Medical Research CouncilDean’s office and Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Public Health Sciences, Karolinska InstitutetAbstract 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.http://link.springer.com/article/10.1186/s12913-018-3778-2Qualitative researchClinical practice guidelinesImplementationPrimary careFocus groupsTheoretical domains framework |
| spellingShingle | Tamara Kredo Sara Cooper Amber Abrams Jocelyn Muller Jimmy Volmink Salla Atkins Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa BMC Health Services Research Qualitative research Clinical practice guidelines Implementation Primary care Focus groups Theoretical domains framework |
| title | Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa |
| title_full | Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa |
| title_fullStr | Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa |
| title_full_unstemmed | Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa |
| title_short | Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa |
| title_sort | using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in south africa |
| topic | Qualitative research Clinical practice guidelines Implementation Primary care Focus groups Theoretical domains framework |
| url | http://link.springer.com/article/10.1186/s12913-018-3778-2 |
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