A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines

This is a failure right from the start;

Clinical practice guidelines

INSTEAD OF

Clinical practice RESULTS or PROTOCOLS. 

A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines

• Karen GrimmerEmail authorView ORCID ID profile,
• Quinette Louw,
• Janine M. Dizon,
• Sjan-Mari Brown,
• Dawn Ernstzen and
• Charles S. Wiysonge

Health Research Policy and Systems201917:56

https://doi.org/10.1186/s12961-019-0454-x

©  The Author(s). 2019

• Received: 21 January 2019
• Accepted: 16 April 2019
• Published: 6 June 2019

Open Peer Review reports

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.