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Knowledge translation: a case study on pneumonia research and clinical guidelines in a low- income country

机译:知识翻译:一个低收入国家关于肺炎研究和临床指南的案例研究

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Background 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. Methods 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. Results 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. Conclusions 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.
机译:背景很少有针对政策制定者的知识翻译(KT)干预的过程和有效性的报道。在一个低收入国家柬埔寨,制定了一项旨在向卫生当局提供有关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。通过案例研究,我们评估了这种KT干预的有效性,目的是确定KT的障碍并提出在类似情况下促进KT的策略。方法对所有相关数据源进行了广泛搜索,以记录更新成人和小儿肺炎指南的过程。文档包括报告,会议记录和电子邮件通信。该研究分多个阶段进行:对成人和小儿肺炎指南的内容进行评估;独立专家使用AGREE-II仪器对指南质量进行评估;使用统一建模语言(UML)工具2.2在指南更新系统中对KT流程进行描述和建模;以及我们在研究过程中确定的阻碍KT的障碍和促进因素的清单。结果首次评估表明,KT关键信息在儿科和成人指南中的整合程度有所不同,在儿科指南中的效率更高。总体上,成人和儿童指南的AGREE-II质量评估得分分别为37%和44%。 “严格发展”和“独立性”领域的得分最低。UML分析强调,相关利益相关者的时间框架和约束条件大不相同,并且有很多机会无法将证据转化为成人肺炎指南。确定了17个促进因素和18个​​潜在的KT障碍。主要障碍与卫生部没有明确授权研究人员以及知识生产与决策之间缺乏同步性有关。结论结论研究结果表明,计划更新LIC中临床指南的利益相关者,研究人员和政策制定者都可能需要方法上的支持来克服预期的障碍。

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