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Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals

BACKGROUND: Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study i...

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Autores principales: Nzinga, Jacinta, Mbindyo, Patrick, Mbaabu, Lairumbi, Warira, Ann, English, Mike
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726115/
https://www.ncbi.nlm.nih.gov/pubmed/19627591
http://dx.doi.org/10.1186/1748-5908-4-44
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author Nzinga, Jacinta
Mbindyo, Patrick
Mbaabu, Lairumbi
Warira, Ann
English, Mike
author_facet Nzinga, Jacinta
Mbindyo, Patrick
Mbaabu, Lairumbi
Warira, Ann
English, Mike
author_sort Nzinga, Jacinta
collection PubMed
description BACKGROUND: Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study in four district hospitals in Kenya. METHODS: We developed a simple interview guide based on a simple characterisation of the intervention informed by review of major theories on barriers to uptake of guidelines. In-depth interviews, non-participatory observation, and informal discussions were then used to explore perceived barriers to guideline introduction and general improvements in paediatric and newborn care. Data were collected four to five months after in-service training in the hospitals. Data were transcribed, themes explored, and revised in two rounds of coding and analysis using NVivo 7 software, subjected to a layered analysis, reviewed, and revised after discussion with four hospital staff who acted as within-hospital facilitators. RESULTS: A total of 29 health workers were interviewed. Ten major themes preventing guideline uptake were identified: incomplete training coverage; inadequacies in local standard setting and leadership; lack of recognition and appreciation of good work; poor communication and teamwork; organizational constraints and limited resources; counterproductive health worker norms; absence of perceived benefits linked to adoption of new practices; difficulties accepting change; lack of motivation; and conflicting attitudes and beliefs. CONCLUSION: While the barriers identified are broadly similar in theme to those reported from high-income settings, their specific nature often differs. For example, at an institutional level there is an almost complete lack of systems to introduce or reinforce guidelines, poor teamwork across different cadres of health worker, and failure to confront poor practice. At an individual level, lack of interest in the evidence supporting guidelines, feelings that they erode professionalism, and expectations that people should be paid to change practice threaten successful implementation.
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spelling pubmed-27261152009-08-13 Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals Nzinga, Jacinta Mbindyo, Patrick Mbaabu, Lairumbi Warira, Ann English, Mike Implement Sci Research Article BACKGROUND: Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study in four district hospitals in Kenya. METHODS: We developed a simple interview guide based on a simple characterisation of the intervention informed by review of major theories on barriers to uptake of guidelines. In-depth interviews, non-participatory observation, and informal discussions were then used to explore perceived barriers to guideline introduction and general improvements in paediatric and newborn care. Data were collected four to five months after in-service training in the hospitals. Data were transcribed, themes explored, and revised in two rounds of coding and analysis using NVivo 7 software, subjected to a layered analysis, reviewed, and revised after discussion with four hospital staff who acted as within-hospital facilitators. RESULTS: A total of 29 health workers were interviewed. Ten major themes preventing guideline uptake were identified: incomplete training coverage; inadequacies in local standard setting and leadership; lack of recognition and appreciation of good work; poor communication and teamwork; organizational constraints and limited resources; counterproductive health worker norms; absence of perceived benefits linked to adoption of new practices; difficulties accepting change; lack of motivation; and conflicting attitudes and beliefs. CONCLUSION: While the barriers identified are broadly similar in theme to those reported from high-income settings, their specific nature often differs. For example, at an institutional level there is an almost complete lack of systems to introduce or reinforce guidelines, poor teamwork across different cadres of health worker, and failure to confront poor practice. At an individual level, lack of interest in the evidence supporting guidelines, feelings that they erode professionalism, and expectations that people should be paid to change practice threaten successful implementation. BioMed Central 2009-07-23 /pmc/articles/PMC2726115/ /pubmed/19627591 http://dx.doi.org/10.1186/1748-5908-4-44 Text en Copyright © 2009 Nzinga et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Nzinga, Jacinta
Mbindyo, Patrick
Mbaabu, Lairumbi
Warira, Ann
English, Mike
Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title_full Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title_fullStr Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title_full_unstemmed Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title_short Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals
title_sort documenting the experiences of health workers expected to implement guidelines during an intervention study in kenyan hospitals
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726115/
https://www.ncbi.nlm.nih.gov/pubmed/19627591
http://dx.doi.org/10.1186/1748-5908-4-44
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