Journal article
‘Involve those who are managing these outbreaks’: stakeholders’ perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda—a thematic network analysis
- Abstract:
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Introduction
Prior research highlighting the complexity of clinical management guidelines’ (CMGs) implementation during high consequence infectious disease (HCID) outbreaks has suggested that limited access to treatments and equipment and substantial issues regarding availability, inclusivity, quality and applicability hinders the implementation of CMGs in low- and middle-income countries (LMICs). This in-depth case study of Uganda—coincidentally occurring during the 2022 Sudan virus disease outbreak—aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation.Methods
Between August and December 2022, 43 interviews were conducted with medical personnel, consultant physicians, case managers and Uganda Ministry of Health officials. Interviews were analysed using a thematic network analysis approach to visualise thematic codes in qualitative data and highlight inherent relationships between codes.Results
Six thematic topics emerged as the main barriers to the implementation of CMGs during HCID outbreaks in Uganda: (1) deficient content and slow updates of CMGs; (2) scarce resources and healthcare disparities; (3) slow dissemination and limited access to guidelines; (4) improvisation of patient care (5) lack of training for healthcare workers (HCWs); and (6) limited pandemic preparedness and response infrastructure. Codes most strongly linked to facilitators and suggestions included: (1) HCW training in CMG implementation; (2) adequate resourcing; (3) involvement of personnel with prior HCID response experience in CMG development and (4) improvements in access to CMGs.Conclusions
By illustrating linkages to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure, our study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties for CMG implementation in LMIC contexts. Findings offer valuable insights for LMICs to improve HCID outbreak responses and inform implementation of CMGs in future HCID outbreaks, where evidence is often initially limited. Recommendations to enhance CMG implementation are provided.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.7MB, Terms of use)
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- Publisher copy:
- 10.1136/bmjph-2024-001165
Authors
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 215091/Z/18/Z
- Publisher:
- BMJ Publishing Group
- Journal:
- BMJ Public Health More from this journal
- Volume:
- 3
- Issue:
- 1
- Article number:
- e001165
- Publication date:
- 2025-02-13
- Acceptance date:
- 2024-12-30
- DOI:
- EISSN:
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2753-4294
- ISSN:
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2753-4294
- Language:
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English
- Pubs id:
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2090305
- Local pid:
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pubs:2090305
- Source identifiers:
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2685000
- Deposit date:
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2025-02-14
- ARK identifier:
Terms of use
- Copyright holder:
- Kabajaasi et al.
- Copyright date:
- 2025
- Rights statement:
- © 2025, The Author(s). Published by BMJ Publishing Group Ltd. his is an open access article distributed under the terms of the Creative Commons CC BY 4.0 license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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