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
type: article
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'