Louw Q.1, Grimmer K.2, Dizon J.3
1Stellenbosch University, Cape Town, South Africa, 2University of Abomey-Calavi South Australia, Adelaide, Australia, 3University of South Australia, Adelaide, Australia
Background: The shifting focus in South African PHC from communicable disease mortality, to communicable and non-communicable disease morbidity, puts the spotlight firmly on evidence-informed allied health (AH) to ensure that resources are used to optimise health and cost outcomes for people living with chronic disease. Primary healthcare clinical practice guidelines (CPGs) in South Africa have contained almost no guidance for AH or rehabilitation. Investing in evidence-based AH care in PHC settings is critical for any nation's health.
Purpose: We aimed to investigate the barriers and facilitators for CPG uptake among AH practitioners in SA.
Methods: We used a qualitative descriptive study approach, informed by semi-structured interviews from 25 key informants in important clusters of AH CPG activity. Purposive maximum variation sampling strategy was used to capture the voices from a heterogeneous reference population . To establish this population, we undertook preliminary investigations to identify clusters of AH activity. Four disciplines involved in PHC rehabilitation and disability in South Africa (physiotherapy, occupational therapy, speech pathology and podiatry) were represented. The study was conducted in line with COREQ reporting standards. All transcripts were transferred into a raw data bundle in Atlas.ti. After reliability was established, the interviews were then randomly assigned to three researchers to independently analyse broad family codes, themes and subthemes.
Results: The themes relevant to barriers and enablers are Interdisciplinary allied health networks, support, challenges to evidence production and implementation and training needs.
AH CPG activities in the South African primary care setting are challenged by fragmentation of effort, lack of training, support, resources and recognition of effort. However the interdisciplinary Allied Health networks in South Africa, which are largely informal, provide a conduit which mediates barriers into many innovative solutions and should be maximized at this point.
Conclusion(s): Given the increasing PHC South African burden of non-communicable disease, for which effective AH plays an important role, it is timely that enablers for PHC CPG activities for AH professionals in South Africa be identified, and acted on, now. The CPG writing and dissemination challenges we identified confirm the need for robust and targeted evidence production, as well as evidence accessibility and coherence of effort. This will ensure that non-communicable chronic disease and disability management will be underpinned by standardised evidence-informed, CPG-driven practices that are cohesively directed from government, written by academics, professional associations, policy-makers, managers and clinicians, and implemented across sectors. Solution-driven practices by AH professionals could lead and improve South African PHC CPG practices for all healthcare providers.
Implications: Innovation in resources are needed to develop models of resource utilisation, prioritisation and coordinated effort for common goals. Training is needed for clinical practice guideline writing and implementation skills. CPGs must be comprehensive, contextualized, accessible and relevant. Stronger relationships between NDoH & PDoH policy-makers, academia, implementers, managers, lead clinicians and private sector are needed.
Funding acknowledgements: The research was funded by the South African Medical Research Council.
Topic: Research methodology & knowledge translation
Ethics approval: Ethical approval was obtained from Stellenbosch University Ethics Committee for Human Research.
All authors, affiliations and abstracts have been published as submitted.
