Addressing implementation challenges during guideline development – a case study of Swedish national guidelines for methods of preventing diseaseReport as inadecuate

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BMC Health Services Research

, 15:19

Health policy, reform, governance and law


BackgroundMany of the world’s life threatening diseases e.g. cancer, heart disease, stroke could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.

MethodsSeven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.

ResultsThe study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.

ConclusionsThis case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.

KeywordsClinical practice guidelines Development process Evidence-based public health Implementation Disease prevention Lifestyle change AbbreviationsAGREEAppraisal of Guidelines for Research and Evaluation

GPGeneral Practitioner

GRADEThe Grading of Recommendations Assessment, Development and Evaluation

NBHWNational Board of Health and Welfare in Sweden

NICEThe National Institute for Health and Care Excellence in the UK

RCTRandomized Controlled Trial

WHOWorld Health Organization

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Author: Linda Richter-Sundberg - Therese Kardakis - Lars Weinehall - Rickard Garvare - Monica E Nyström


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