2023-09-28 14:46:10 +00:00
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abstract: 'Background: Although considerable efforts are directed at developing
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international guidelines to improve clinical management in low-income
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settings they appear to influence practice rarely. This study aimed to
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explore barriers to guideline implementation in the early phase of an
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intervention study in four district hospitals in Kenya.
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Methods: We developed a simple interview guide based on a simple
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characterisation of the intervention informed by review of major
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theories on barriers to uptake of guidelines. In-depth interviews,
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non-participatory observation, and informal discussions were then used
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to explore perceived barriers to guideline introduction and general
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improvements in paediatric and newborn care. Data were collected four to
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five months after in-service training in the hospitals. Data were
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transcribed, themes explored, and revised in two rounds of coding and
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analysis using NVivo 7 software, subjected to a layered analysis,
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reviewed, and revised after discussion with four hospital staff who
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acted as within-hospital facilitators.
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Results: A total of 29 health workers were interviewed. Ten major themes
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preventing guideline uptake were identified: incomplete training
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coverage; inadequacies in local standard setting and leadership; lack of
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recognition and appreciation of good work; poor communication and
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teamwork; organizational constraints and limited resources;
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counterproductive health worker norms; absence of perceived benefits
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linked to adoption of new practices; difficulties accepting change; lack
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of motivation; and conflicting attitudes and beliefs.
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Conclusion: While the barriers identified are broadly similar in theme
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to those reported from high-income settings, their specific nature often
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differs. For example, at an institutional level there is an almost
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complete lack of systems to introduce or reinforce guidelines, poor
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teamwork across different cadres of health worker, and failure to
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confront poor practice. At an individual level, lack of interest in the
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evidence supporting guidelines, feelings that they erode
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professionalism, and expectations that people should be paid to change
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practice threaten successful implementation.'
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affiliation: 'Nzinga, J (Corresponding Author), KEMRI Wellcome Trust Programme, KEMRI
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Ctr Geog Med Res Coast, POB 43640, Nairobi, Kenya.
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Nzinga, Jacinta; Mbindyo, Patrick; Mbaabu, Lairumbi; Warira, Ann; English, Mike,
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KEMRI Wellcome Trust Programme, KEMRI Ctr Geog Med Res Coast, Nairobi, Kenya.
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English, Mike, Univ Oxford, John Radcliffe Hosp, Dept Paediat, Oxford OX3 9DU, England.'
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article-number: '44'
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author: Nzinga, Jacinta and Mbindyo, Patrick and Mbaabu, Lairumbi and Warira, Ann
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and English, Mike
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author-email: 'jnzinga@nairobi.kemri-wellcome.org
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pmbindyo@nairobi.kemri-wellcome.org
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lmbaabu@nairobi.kemri-wellcome.org
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awarira@nairobi.kemri-wellcome.org
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menglish@nairobi.kemri-wellcome.org'
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author_list:
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- family: Nzinga
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given: Jacinta
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- family: Mbindyo
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given: Patrick
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- family: Mbaabu
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given: Lairumbi
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- family: Warira
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given: Ann
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- family: English
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given: Mike
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da: '2023-09-28'
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doi: 10.1186/1748-5908-4-44
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files: []
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issn: 1748-5908
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journal: IMPLEMENTATION SCIENCE
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keywords-plus: 'CLINICAL-PRACTICE GUIDELINES; DISTRICT HOSPITALS; CHILDHOOD ILLNESS;
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PLANNED BEHAVIOR; PEDIATRIC CARE; PUBLIC-SECTOR; NEWBORN CARE; QUALITY;
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MOTIVATION; MANAGEMENT'
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language: English
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month: JUL 23
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number-of-cited-references: '34'
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orcid-numbers: 'Mbindyo, Patrick/0000-0003-0388-0026
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Wanjuhi, Anne/0000-0002-4182-6939
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English, Michael/0000-0002-7427-0826'
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papis_id: 3747e16ca0f8c9066ad5bba84785e2d7
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ref: Nzinga2009documentingexperienc
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times-cited: '44'
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title: Documenting the experiences of health workers expected to implement guidelines
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during an intervention study in Kenyan hospitals
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000268892000001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '16'
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volume: '4'
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web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
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year: '2009'
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