Challenges of disseminating clinical practice guidelines in a weak health system: the case of HIV and infant feeding recommendations in Tanzania
Journal article, Peer reviewed
Permanent lenke
http://hdl.handle.net/11250/2373625Utgivelsesdato
2014Metadata
Vis full innførselSamlinger
Originalversjon
Shayo, E.H., Våga, B.B., Moland, K.M. et al. (2014) Challenges of disseminating clinical practice guidelines in a weak health system: the case of HIV and infant feeding recommendations in Tanzania. International Breastfeeding Journal 2014, 9(1) 10.1186/s13006-014-0024-3Sammendrag
Background:
Clinical guidelines aim to improve patient outcomes by providing recommendations on appropriate
healthcare for specific clinical conditions. Scientific evidence produced over time leads to change in clinical
guidelines, and a serious challenge may emerge in the process of communicating the changes to healthcare
practitioners and getting new practices adopted. There is very little information on the major barriers to
implementing clinical guidelines in low-income settings. Looking at how continual updates to clinical guidelines
within a particular health intervention are communicated may shed light on the processes at work. The aim of this
paper is to explore how the content of a series of diverging infant feeding guidelines have been communicated to
managers in the Prevention of Mother to Child Transmission of HIV Programme (PMTCT) with the aim of generating
knowledge about both barriers and facilitating factors in the dissemination of new and updated knowledge in
clinical guidelines in the context of weak healthcare systems.
Methods:
A total of 22 in-depth interviews and two focus group discussions were conducted in 2011. All
informants were linked to the PMTCT programme in Tanzania. The informants included managers at regional and
district levels and health workers at health facility level.
Results:
The informants demonstrated partial and incomplete knowledge about the recommendations. There was
lack of scientific reasoning behind various infant feeding recommendations. The greatest challenges to the
successful communication of the infant feeding guidelines were related to slowness of communication, inaccessible
jargon-ridden English language in the manuals, lack of summaries, lack of supportive supervision to make the
guidelines comprehensible, and the absence of a reading culture.
Conclusion:
The study encountered substantial gaps in knowledge about the diverse HIV and infant feeding
policies. These gaps were partly related to the challenges of communicating the clinical guidelines. There is a need
for caution in assuming that important changes in guidelines for clinical practice can easily be translated to and
implemented in local programme settings, not least in the context of weak healthcare systems.
Beskrivelse
© 2015 Shayo et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License and originally published in the International Breastfeeding Journal. See DOI 10.1186/s13006-014-0024-