wow-inequalities/02-data/intermediate/wos_sample/9351faae9b27dfc180eb1b13bf0d50c3-nzinga-jacinta-and/info.yaml

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2023-09-28 14:46:10 +00:00
abstract: '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.'
affiliation: 'Nzinga, J (Corresponding Author), KEMRI Wellcome Trust Programme, KEMRI
Ctr Geog Med Res Coast, POB 43640, Nairobi, Kenya.
Nzinga, Jacinta; Mbindyo, Patrick; Mbaabu, Lairumbi; Warira, Ann; English, Mike,
KEMRI Wellcome Trust Programme, KEMRI Ctr Geog Med Res Coast, Nairobi, Kenya.
English, Mike, Univ Oxford, John Radcliffe Hosp, Dept Paediat, Oxford OX3 9DU, England.'
article-number: '44'
author: Nzinga, Jacinta and Mbindyo, Patrick and Mbaabu, Lairumbi and Warira, Ann
and English, Mike
author-email: 'jnzinga@nairobi.kemri-wellcome.org
pmbindyo@nairobi.kemri-wellcome.org
lmbaabu@nairobi.kemri-wellcome.org
awarira@nairobi.kemri-wellcome.org
menglish@nairobi.kemri-wellcome.org'
author_list:
- family: Nzinga
given: Jacinta
- family: Mbindyo
given: Patrick
- family: Mbaabu
given: Lairumbi
- family: Warira
given: Ann
- family: English
given: Mike
da: '2023-09-28'
doi: 10.1186/1748-5908-4-44
files: []
issn: 1748-5908
journal: IMPLEMENTATION SCIENCE
keywords-plus: 'CLINICAL-PRACTICE GUIDELINES; DISTRICT HOSPITALS; CHILDHOOD ILLNESS;
PLANNED BEHAVIOR; PEDIATRIC CARE; PUBLIC-SECTOR; NEWBORN CARE; QUALITY;
MOTIVATION; MANAGEMENT'
language: English
month: JUL 23
number-of-cited-references: '34'
orcid-numbers: 'Mbindyo, Patrick/0000-0003-0388-0026
Wanjuhi, Anne/0000-0002-4182-6939
English, Michael/0000-0002-7427-0826'
papis_id: 3747e16ca0f8c9066ad5bba84785e2d7
ref: Nzinga2009documentingexperienc
times-cited: '44'
title: Documenting the experiences of health workers expected to implement guidelines
during an intervention study in Kenyan hospitals
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000268892000001
usage-count-last-180-days: '0'
usage-count-since-2013: '16'
volume: '4'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2009'