Exploring barriers and facilitators to South African primary care clinical guideline implementation: perspective of clinicians




Short oral session 4: Evidence implementation and evaluation


Wednesday 13 September 2017 - 16:00 to 17:30


All authors in correct order:

Kredo T1, Muller J1, Mokganyetji T1, Abrams A2, Daniels K3, Atkins S4
1 Cochrane South Africa, South African Medical Research Centre, South Africa
2 Cochrane South Africa, South African Medical Research Council, South Africa
3 Health Systems Research Unit, South African Medical Research Council, South Africa
4 Department of Public Health Sciences, Karolinska Institutet, Finland
Presenting author and contact person

Presenting author:

Tamara Kredo

Contact person:

Abstract text
Background: Clinical practice guidelines (CPGs) risk having little impact on healthcare worker practice, if not effectively disseminated, communicated and implemented. The South African Guidelines Excellence (SAGE) project is a collaborative project exploring the CPG landscape in South African primary care including engaging primary care healthcare workers regarding their perspectives on CPGs.

Objectives: Exploring barriers to and facilitators for CPG implementation and use by South African primary care clinicians.

Methods: We conducted 7 focus groups in 4 provinces in South Africa. Clinicians included: nurses, dieticians, dentists, doctors and allied health practitioners, from primary care facilities in rural, urban and peri-urban settings. We used semi-structured interview guides and transcribed these verbatim. We adopted a thematic approach to analysis which was iterative and integrated into all phases of the research. The rigour applied to data collection and analysis is reflected in an audit trail that includes post-interview reflective summaries, peer debriefings, and expert input into analysis workshops for enhancing intercoder reliability and agreement.

Results: Focus groups took place between November 2015 and August 2016 in the Eastern Cape, Western Cape, Kwazulu-Natal and Limpopo provinces. Clinicians at facilities were receptive to using CPGs, and generally felt enabled by them. Nurses felt more independent with increased confidence to treat patients where doctors were scarce. Enablers include ‘ease of use’ such as design features, using local language, training and physical access to CPGs; ‘system-level facilitators’ include supportive audits to help identify gaps, accessible clinical support and community involvement for accountability; other enablers included ‘strong teamwork’; and ‘involvement of partner non-governmental organisations’. Barriers generally mirrored enablers.

Conclusions: Primary care clinicians’ perspectives on potential enablers to CPG use can help identify approaches to better implement these to improve South African healthcare.