A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines
Date
2019-06-06
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to
increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of
practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local
practice. This paper describes South African experiences in implementing international CPG recommendations for
best practice stroke rehabilitation into local contexts, using a purpose-build approach.
Methods: Composite recommendations were synthesised from 16 international CPGs to address end-user
questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the
project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke
survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on
endorsement and development of implementation strategies. Where recommendations required contextualisation to
address local barriers before they could be effectively implemented, prompts were provided to identify barriers and
possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation),
options were identified to establish new evidence.
Findings: The structured implementation process was efficient in terms of time, effort, resources and problem solving.
The process empowered the project team to make practical decisions about local uptake of international
recommendations, develop local implementation strategies, and determine who was responsible, for what and
when. Different implementation strategies for the same recommendation were identified for different settings,
to address different barriers.
Conclusion: The South African evidence translation experience could be useful for evidence implementers in
other countries, when translating CPG recommendations developed elsewhere, into local practice.
Description
CITATION: Grimmer, K., et al. 2019. A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines. Health Research Policy and Systems, 17:56, doi:10.1186/s12961-019-0454-x.
The original publication is available at https://health-policy-systems.biomedcentral.com
The original publication is available at https://health-policy-systems.biomedcentral.com
Keywords
Cerebrovascular disease -- Patients -- Rehabilitation -- South Africa, Clinical medicine -- Practice -- South Africa, Medical protocols -- South Africa
Citation
Grimmer, K., et al. 2019. A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines. Health Research Policy and Systems, 17:56, doi:10.1186/s12961-019-0454-x