From Policy to Practice
Open Access DepositedExploring Public Health Guidelines Adaptation Strategies in Sub-Saharan Africa and Factors that may Influence the Implementation of Cancer Survivorship Guidelines in Nigeria
Research implications are specifically drawn from the descriptive qualitative study. This study provides the first comprehensive analysis of healthcare guideline adaptation methods in Sub-Saharan Africa and is the first in West Africa to explore factors that may inform the implementation of cancer survivorship guidelines through an exploration of the cancer care pathway. The findings advance implementation science by demonstrating the need for systematic, context-specific/sensitive approaches to guideline adaptation that consider local resources, cultural factors, and existing healthcare infrastructure. Several recommendations for addressing implementation barriers through multi-level interventions are also proposed.
What are the common practices and approaches used in Sub-Saharan Africa to adapt public health guidelines to local contexts? RQ2
What organizational factors, based on individual perception, experiences, and practices in oncology care, may hinder or facilitate new guideline implementation? RQ4
The translation of clinical and public health guidelines into practice remains a persistent challenge. In resource-limited settings, this challenge is particularly heightened due to limited resources, competing priorities, inadequate infrastructure, and limited human resources for health. Additionally, often, guidelines being implemented are developed in Western contexts, leading to misalignment between recommendations and realities of local contexts. The National Comprehensive Cancer Network (NCCN) recently developed harmonized survivorship guidelines for Sub-Saharan Africa, and Nigeria has integrated survivorship in its most recent national cancer control plan. However, little is known about the contextual factors that may influence the implementation of the proposed cancer survivorship guidelines in Nigeria. Research Questions
The scoping review revealed three critical aspects of guideline implementation
What external factors, based on individual perceptions, practices, and attitudes in the oncology care pathway, may hinder or facilitate guideline implementation? RQ5
What individual-level factors drawn from experiences and practices during the cancer care pathway may hinder or facilitate guideline implementation? Methods
The study employed a two-phase approach. Phase one consisted of a systematic scoping review following PRISMA-ScR guidelines, analyzing 25 studies on guideline adaptation methods in Sub-Saharan Africa published between 2014-2024. Phase two involved a qualitative inquiry using the Consolidated Framework for Implementation Research (CFIR) to conduct key informant interviews with 22 participants (9 patients, 9 healthcare providers, 4 caregivers) at a major Nigerian cancer center. Findings
(i) the evolution of adaptation methods from unstructured to more systematic approaches, (ii) persistent implementation barriers across healthcare systems, and (iii) the emerging role of implementation science frameworks to assess and address implementation limitations. Most studies employed the "copy or customize" adaptation mode, with increasing use of structured tools like AGREE II and GRADE frameworks. The qualitative study highlighted several key barriers that may influence the implementation of cancer survivorship guidelines, such as limited awareness among providers about the guidelines, human resource shortages, and financial-related challenges. However, sociocultural factors, along with effective communication strategies and networks, were identified as facilitators that may be leveraged. The study highlights the significant connection between individuals, institutions, and the community along the cancer care pathway that may influence guideline implementation and thus emphasizes the need for context-specific adaptation and implementation strategies. The scoping review identified the tremendous effort, expertise, and resources that are required to develop denovo guidelines, substantiating the importance of advancing resource-stratified guidelines to better support the implementation of evidence-based research in low- and middle-income settings. Building on this, the qualitative study identifies the next critical steps in developing evidence-based implementation strategies that specifically address the typical barriers and facilitators encountered in specific settings. Research Implications and Significance
RQ1
What are the lived experiences of patients and caregivers receiving care at a satellite facility based on the standard of care and current community support? RQ3
Exploring Public Health Guidelines Adaptation Strategies in Sub-Saharan Africa and Factors that may Influence the Implementation of Cancer Survivorship Guidelines in Nigeria Background
Abstract of Dissertation From Policy to Practice
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