Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, Australia.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
BMC Public Health. 2020 Nov 23;20(1):1758. doi: 10.1186/s12889-020-09812-0.
The World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines.
A grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding.
We categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines.
In comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances.
This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).
世界卫生组织（WHO）发布了大量临床实践和公共卫生指南，以促进全球循证实践。由于不同地区和国家的卫生系统能力和背景问题各不相同，因此将指南中的建议适应当地情况对于其实施的成功至关重要。我们旨在从 WHO 区域和国家办事处工作人员的角度了解指南改编的经验范围。我们的研究结果将为如何提高 WHO 指南的适应性提供指导。
这是一项基于扎根理论的定性研究，于 2018 年 3 月至 12 月进行。从总部、区域和国家办事处的指南制定者和工作人员中，根据已发表的 WHO 指南样本，抽取了 17 名半结构式访谈参与者。如果参与者最近有临床实践或公共卫生指南实施经验，则有资格参加招募。对这些访谈的匿名转录本进行了三轮编码分析。
我们将参与者描述的适应过程分为两种主导模式，沿着适应过程的范围。首先，复制或定制模型是一种实用的方法，即根据当地需求复制或定制 WHO 指南。这是通过当地卫生当局和/或临床医生直接与 WHO 工作人员协商完成的。实施者通过共识讨论，根据他们认为重要、可行和适用的内容，对指南建议进行选择和调整。其次，能力建设模型侧重于 WHO 建立证据综合方法和适应框架的能力，以支持根据国际指南制定国家指南。
在比较和对比这两种指南适应模式时，我们概述了 WHO 可能需要提供的不同支持，以提高各自模式的有效性和效率。我们还建议在 WHO 和学术文献中对指南适应过程的描述进行澄清，以帮助指南改编者和实施者根据其具体情况决定适当的行动方案。
本项目经悉尼大学（项目编号：2017/723）和世界卫生组织（协议 ID：00001）伦理批准。
