'How to know what you need to do': a cross-country comparison of maternal health guidelines in Burkina Faso, Ghana and Tanzania
'How to know what you need to do': a cross-country comparison of maternal health guidelines in Burkina Faso, Ghana and Tanzania
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DOI：
10.1186/1748-5908-7-31
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发表时间：
2012-04-13
影响因子：
7.2
通讯作者：
Eriksen, Jaran
中科院分区：
文献类型：
--
作者：
Baker, Ulrika;Tomson, Goeran;Eriksen, Jaran
背景：提高向母亲提供的护理质量的举措需要在撒哈拉以南非洲（SSA）得到优先考虑。临床实践指南（CPG）的推广是一种常见的策略，但其实施往往具有挑战性，限制了其潜在的影响。通过跨国视角，本研究探讨了布基纳法索，加纳和坦桑尼亚孕产妇健康的CPG。目的是比较与CPG使用相关的因素，包括与世界卫生组织（WHO）指南相比的内容，格式及其开发过程。此外，还探讨了对这些工具的可得性和实际使用情况的看法。总体目的是进一步了解如何增加CPGs的潜力，以提高护理质量的母亲在SSA.Methods：本研究是一个多案例研究设计，包括跨国比较，使用文件审查和关键的线人访谈。一个概念框架，以帮助分析和讨论的结果，包括选定的领域有关的准则的可实施性和卫生工作者在实践中使用的可用性，适用性和adaptability.Results：这项研究揭示了一些显着差异的内容之间的国家指导方针孕产妇健康和世界卫生组织的建议。然而，这三个国家的国家方案目标的格式有明显的差异。除了加纳和坦桑尼亚的一个CPG之外，可用性和适用性的水平被评估为低或中等。在这三个国家，使用CPGs的卫生工作者在实践中被认为是limited.Conclusion：我们的跨国研究表明，它不是质量差的内容或缺乏证据基础，构成了主要障碍CPGs的积极影响，在SSA孕产妇保健质量的提高。相反，它强调需要优先考虑准则的格式，以提高其可用性和适用性，并将这些属性与实施战略一起视为其制定过程的组成部分。
Background: Initiatives to raise the quality of care provided to mothers need to be given priority in Sub Saharan Africa (SSA). The promotion of clinical practice guidelines (CPGs) is a common strategy, but their implementation is often challenging, limiting their potential impact. Through a cross-country perspective, this study explored CPGs for maternal health in Burkina Faso, Ghana, and Tanzania. The objectives were to compare factors related to CPG use including their content compared with World Health Organization (WHO) guidelines, their format, and their development processes. Perceptions of their availability and use in practice were also explored. The overall purpose was to further the understanding of how to increase CPGs' potential to improve quality of care for mothers in SSA.Methods: The study was a multiple case study design consisting of cross-country comparisons using document review and key informant interviews. A conceptual framework to aid analysis and discussion of results was developed, including selected domains related to guidelines' implementability and use by health workers in practice in terms of usability, applicability, and adaptability.Results: The study revealed few significant differences in content between the national guidelines for maternal health and WHO recommendations. There were, however, marked variations in the format of CPGs between the three countries. Apart from the Ghanaian and one of the Tanzanian CPGs, the levels of both usability and applicability were assessed as low or medium. In all three countries, the use of CPGs by health workers in practice was perceived to be limited.Conclusion: Our cross-country study suggests that it is not poor quality of content or lack of evidence base that constitute the major barrier for CPGs to positively impact on quality improvement in maternal care in SSA. It rather emphasises the need to prioritise the format of guidelines to increase their usability and applicability and to consider these attributes together with implementation strategies as integral to their development processes.