Goyet Sophie, Barennes Hubert, Libourel Therese, van Griensven Johan, Frutos Roger, Tarantola Arnaud
Epidemiology and Public Health Unit, Institut Pasteur, Phnom Penh, Cambodia.
Implement Sci. 2014 Jun 26;9:82. doi: 10.1186/1748-5908-9-82.
The process and effectiveness of knowledge translation (KT) interventions targeting policymakers are rarely reported. In Cambodia, a low-income country (LIC), an intervention aiming to provide evidence-based knowledge on pneumonia to health authorities was developed to help update pediatric and adult national clinical guidelines. Through a case study, we assessed the effectiveness of this KT intervention, with the goal of identifying the barriers to KT and suggest strategies to facilitate KT in similar settings.
An extensive search for all relevant sources of data documenting the processes of updating adult and pediatric pneumonia guidelines was done. Documents included among others, reports, meeting minutes, and email correspondences. The study was conducted in successive phases: an appraisal of the content of both adult and pediatric pneumonia guidelines; an appraisal of the quality of guidelines by independent experts, using the AGREE-II instrument; a description and modeling of the KT process within the guidelines updating system, using the Unified Modeling Language (UML) tools 2.2; and the listing of the barriers and facilitators to KT we identified during the study.
The first appraisal showed that the integration of the KT key messages in pediatric and adult guidelines varied with a better efficiency in the pediatric guidelines. The overall AGREE-II quality assessments scored 37% and 44% for adult and pediatric guidelines, respectively. Scores were lowest for the domains of 'rigor of development' and 'editorial independence.' The UML analysis highlighted that time frames and constraints of the involved stakeholders greatly differed and that there were several missed opportunities to translate on evidence into the adult pneumonia guideline. Seventeen facilitating factors and 18 potential barriers to KT were identified. Main barriers were related to the absence of a clear mandate from the Ministry of Health for the researchers and to a lack of synchronization between knowledge production and policy-making.
Study findings suggest that stakeholders, both researchers and policy makers planning to update clinical guidelines in LIC may need methodological support to overcome the expected barriers.
针对政策制定者的知识转化（KT）干预措施的过程和效果鲜有报道。在柬埔寨这个低收入国家，开发了一项旨在向卫生当局提供关于肺炎的循证知识的干预措施，以帮助更新儿科和成人国家临床指南。通过一项案例研究，我们评估了这项KT干预措施的效果，目的是识别KT的障碍并提出在类似环境中促进KT的策略。
广泛搜索记录成人和儿科肺炎指南更新过程的所有相关数据来源。文件包括报告、会议记录和电子邮件通信等。该研究分阶段进行：对成人和儿科肺炎指南的内容进行评估；由独立专家使用AGREE-II工具对指南质量进行评估；使用统一建模语言（UML）工具2.2对指南更新系统内的KT过程进行描述和建模；列出我们在研究过程中识别出的KT的障碍和促进因素。
首次评估表明，KT关键信息在儿科和成人指南中的整合情况各不相同，儿科指南中的效率更高。成人和儿科指南的AGREE-II总体质量评估得分分别为37%和44%。“制定的严谨性”和“编辑独立性”领域的得分最低。UML分析突出显示，相关利益攸关方的时间框架和限制差异很大，并且在将证据转化为成人肺炎指南方面存在多个错失的机会。确定了17个促进因素和18个KT的潜在障碍。主要障碍与卫生部未向研究人员明确授权以及知识生产与政策制定之间缺乏同步有关。
研究结果表明，计划在低收入国家更新临床指南的研究人员和政策制定者等利益攸关方可能需要方法学支持来克服预期的障碍。
