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Sekome K.1
1University of the Witwatersrand, Physiotherapy Department, Johannesburg, South Africa
Background: Stroke is one of the top leading causes of death worldwide but the largest burden related to this condition occurs in low and middle income countries. In 2013, stroke accounted for 82.4% of all deaths in South Africa and in 2008 stroke was responsible for 95 000 years lived with disability. In the absence of a pathological cure for stroke, the most effective management remains rehabilitation. The use of clinical evidence-based practice helps to ensure a uniform level of care across all health sectors. Studies report that the use of clinical practice guidelines amongst health care practitioners is very low and the reason for this is not well understood.
Purpose: The aim of the study was to explore rehabilitation practitioners' perceptions of clinical practice guidelines for stroke management when working in rural primary care hospitals in the Bushbuckridge local municipality in Mpumalanga province, South Africa.
Methods: A qualitative study using purposive sampling was undertaken at three primary care hospitals in Bushbuckridge local municipality. Face to face in-depth interviews were conducted with study participants. Interviews were audio-recorded. Data were transcribed verbatim by an independent transcriber and verified by the researcher. An inductive approach to qualitative data analysis was used to generate common themes and sub-themes from the transcribed data. Data were analyzed manually by the researcher.
Results: Sixteen rehabilitation practitioners (physiotherapists [n= 7], occupational therapists [n= 5], speech therapists & audiologists [n= 4]) employed at the hospitals consented to participate in the study. The mean duration of employment at the hospital was 21.25 months. Analysis of the data revealed a total of seven themes: 1) Familiarity and application, 2) Guideline functions, 3) Value of guidelines, 4) Patient management conducts, 5) Barriers affecting guideline utilization, 6) Communication, content and design improvements, 7) Evaluations and staff training.
Conclusion(s): Rehabilitation practitioners in rural Bushbuckridge municipality have little knowledge about the clinical practice guidelines for stroke management. The study also revealed that although therapists reported the use of clinical practice guidelines beneficial for patient rehabilitation, the uptake was very low. This study also revealed that most therapists were not aware of the difference between a clinical practice guideline and a clinical protocol.
Implications: The clinical practice guidelines for stroke management need to be made available to therapists and strategies to improve their implementation need to be developed in consultation with the therapists at grassroots level. The findings of this study may be used by relevant stakeholders to start conversations with therapists to improve knowledge and utilization of clinical practice guidelines.
Funding acknowledgements: The study was funded by the author.
Topic: Neurology: stroke
Ethics approval: Ethical clearance obtained from the Human Research Ethics Committee (HREC) of the University of the Witwatersrand. Ethical clearance number: M151180
All authors, affiliations and abstracts have been published as submitted.
