National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa

 

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dc.contributor.author Kredo, Tamara
dc.contributor.author Cooper, Sara
dc.contributor.author Abrams, Amber
dc.contributor.author Daniels, Karen
dc.contributor.author Volmink, Jimmy
dc.contributor.author Atkins, Salla
dc.date.accessioned 2018-09-10T07:04:47Z
dc.date.available 2018-09-10T07:04:47Z
dc.date.issued 2018-07-31
dc.identifier.citation Kredo, T., Cooper, S., Abrams, A., Daniels, K., Volmink, J., & Atkins, S. (2018). National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health research policy and systems, 16(1), 68.
dc.identifier.uri https://doi.org/10.1186/s12961-018-0348-3
dc.identifier.uri http://hdl.handle.net/11427/28445
dc.description.abstract Background There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
dc.language.iso en
dc.publisher BioMed Central
dc.source Health Research Policy and Systems
dc.source.uri https://health-policy-systems.biomedcentral.com/
dc.subject.other Clinical practice guideline
dc.subject.other Primary healthcare
dc.subject.other Qualitative study
dc.subject.other Guideline development
dc.title National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa
dc.type Journal Article
dc.date.updated 2018-08-05T03:50:11Z
dc.rights.holder The Author(s).
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Public Health and Family Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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