Article type
Year
Abstract
Background:
In Kenya, as in many low-income countries, clinical guidelines are often formulated through direct adoption or adaptation of global guidance. We report the recent experiences of Kenyan policy makers using the GRADE approach to formulate evidence-informed recommendations around three priority pediatric topics.
Methods:
We invited participants from the 2013 guideline panels for in-depth interviews. All interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach.
Results:
Seventeen participants were interviewed, drawn from public and private health facilities and the ministry of health. Ten had no prior experience of the GRADE approach. Our analysis of the transcripts identified five key emergent themes.
1. Debating the evidence increases confidence: participants linked clear understanding of the evidence with improved confidence that the right recommendations had been made, and felt able to justify the recommendations to others.
2. Panel involvement facilitates ownership: participants considered broad inclusion on guideline panels essential to promote ownership of the recommendations, and ensure timely dissemination and implementation.
3. Mixed views on capacity for wider adoption: participants valued the transparency and methodological rigour of the GRADE approach, but stated wider adoption would require further training and considerable investment of time and money.
4. Consideration of national context important: participants universally stated that knowledge and understanding of the national context were essential for effective national policies, and some felt wider consultation in global guideline processes would improve their usefulness.
5. Implementation is the weakest link: participants gave examples of recommendations made years before that remain unimplemented, and noted that global policy often moved too quickly for countries to keep up.
Conclusion:
There is enthusiasm for rigorous, context specific, guideline development, but wider adoption will require investment of time and money. Regional collaboration, sharing information and resources, would reduce duplication of efforts.
In Kenya, as in many low-income countries, clinical guidelines are often formulated through direct adoption or adaptation of global guidance. We report the recent experiences of Kenyan policy makers using the GRADE approach to formulate evidence-informed recommendations around three priority pediatric topics.
Methods:
We invited participants from the 2013 guideline panels for in-depth interviews. All interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach.
Results:
Seventeen participants were interviewed, drawn from public and private health facilities and the ministry of health. Ten had no prior experience of the GRADE approach. Our analysis of the transcripts identified five key emergent themes.
1. Debating the evidence increases confidence: participants linked clear understanding of the evidence with improved confidence that the right recommendations had been made, and felt able to justify the recommendations to others.
2. Panel involvement facilitates ownership: participants considered broad inclusion on guideline panels essential to promote ownership of the recommendations, and ensure timely dissemination and implementation.
3. Mixed views on capacity for wider adoption: participants valued the transparency and methodological rigour of the GRADE approach, but stated wider adoption would require further training and considerable investment of time and money.
4. Consideration of national context important: participants universally stated that knowledge and understanding of the national context were essential for effective national policies, and some felt wider consultation in global guideline processes would improve their usefulness.
5. Implementation is the weakest link: participants gave examples of recommendations made years before that remain unimplemented, and noted that global policy often moved too quickly for countries to keep up.
Conclusion:
There is enthusiasm for rigorous, context specific, guideline development, but wider adoption will require investment of time and money. Regional collaboration, sharing information and resources, would reduce duplication of efforts.