Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
School of Nursing and Midwifery (SONAM), Aga Khan University, Dar es Salaam, Tanzania.
Health Expect. 2024 Oct;27(5):e70073. doi: 10.1111/hex.70073.
Healthcare providers' role in co-creating health interventions and implementation strategies has evolved significantly, and yet, there is little documentation of this from low-resource settings. This study aims to share the dilemmas of engaging healthcare providers in co-creating locally adapted clinical guidelines for maternity facilities in Dar es Salaam, Tanzania, and strategies used to address them.
An ethnographic study explored the co-creation of locally adapted clinical guidelines for childbirth care within five maternity facilities in Dar es Salaam. Participant observations were conducted during 11 co-creation workshops. Six in-depth interviews explored participant experiences. Data were analyzed using Attride-Stirling's thematic network analysis framework.
The analysis revealed four themes representing dilemmas in the co-creation process and strategies to improve co-creation: (i) navigating diverse contexts: adapting a single set of guidelines to various, diverse facilities was challenging; this was addressed through engaging in dialogue and flexibility while adjusting care practices. (ii) Competing knowledge systems and sources: differing knowledge sources between researchers and healthcare providers challenged discussions on recommended practices. However, validating scientific recommendations with practical care experience in this context helped bridge this gap. (iii) Fostering meaningful participation: participation was time-consuming for some. However, early stakeholder engagement and facility-led participant selection facilitated the meaningful involvement of healthcare providers. (iv) Power imbalances: power dynamics influenced the co-creation process; involving stakeholders in planning and co-facilitating workshops helped mitigate these imbalances and encourage more equal participation.
Navigating contextual variation, differences in knowledge systems, meaningful participation and power dynamics were key challenges in the co-creation process. However, reflexivity, open and honest dialogue with stakeholders and early engagement enhanced the co-creation process. Co-creating locally adapted clinical guidelines with frontline healthcare workers and scientific experts is essential for feasibility and safety. Further research is needed to explore context specificity, decision-making and the efficacy of co-creation in low-resource settings.
Healthcare providers and health managers from five maternity facilities who participated in the co-creation process were actively involved in this study by providing their consent to be interviewed about their experiences of participation.
This study is a substudy within the PartoMa project. PartoMa is a registered clinical trial with the trial registration number NCT04685668. PartoMa's date of initial trial registration is 28 December 2020.
医疗保健提供者在共同创建健康干预措施和实施策略方面的角色发生了重大变化，但在资源匮乏的环境中，几乎没有对此进行记录。本研究旨在分享坦桑尼亚达累斯萨拉姆的医疗机构参与共同制定适用于当地的产妇保健临床指南所面临的困境，以及为解决这些问题而采取的策略。
一项人种学研究探索了在达累斯萨拉姆的五家妇产科医院内共同制定适用于分娩护理的本土化临床指南。在 11 次共同创作研讨会上进行了参与者观察。通过 6 次深入访谈探讨了参与者的经验。使用Attride-Stirling 的主题网络分析框架对数据进行分析。
分析结果揭示了共同创作过程中的四个主题，这些主题代表了共同创作过程中的困境和改进共同创作的策略：（一）在多样化的背景下进行导航：将一套指南应用于各种不同的设施极具挑战性；通过对话和灵活性来解决这个问题，同时调整护理实践。（二）竞争的知识体系和来源：研究人员和医疗保健提供者之间的知识来源不同，这对讨论推荐实践产生了影响。然而，在这种情况下，用实际护理经验验证科学建议有助于弥合这一差距。（三）促进有意义的参与：对一些人来说，参与需要花费大量时间。但是，尽早让利益相关者参与并由医疗机构选择参与者，有助于让医疗保健提供者有意义地参与进来。（四）权力不平衡：权力动态影响共同创作过程；让利益相关者参与计划和共同主持研讨会有助于减轻这些不平衡，并鼓励更平等的参与。
在共同创作过程中，应对情境变化、知识体系差异、有意义的参与和权力动态是关键挑战。然而，通过反思、与利益相关者进行坦诚的对话以及早期参与，增强了共同创作过程。与一线医护人员和科学专家共同制定本土化临床指南对于可行性和安全性至关重要。需要进一步研究来探讨资源匮乏环境下的情境特异性、决策和共同创作的效果。
来自五家妇产科医院的医疗保健提供者和卫生管理人员参与了共同创作过程，他们积极参与了这项研究，同意接受采访，分享他们参与的经验。
本研究是 PartoMa 项目的一个子研究。PartoMa 是一项已注册的临床试验，注册号为 NCT04685668。PartoMa 的初始试验注册日期为 2020 年 12 月 28 日。
