Determinants of Implementation of a Clinical Practice Guideline for Homeless Health

Olivia Magwood, Amanda Hanemaayer, Ammar Saad, Ginetta Salvalaggio, Gary Bloch, Aliza Moledina, Nicole Pinto, Layla Ziha, Michael Geurguis, Alexandra Aliferis, Victoire Kpade, Neil Arya, Tim Aubry and Kevin Pottie
Additional contact information
Olivia Magwood: Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Amanda Hanemaayer: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
Ammar Saad: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
Ginetta Salvalaggio: Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
Gary Bloch: Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
Aliza Moledina: Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Nicole Pinto: Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
Layla Ziha: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
Michael Geurguis: Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
Alexandra Aliferis: Michael C. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
Victoire Kpade: Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
Neil Arya: Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
Tim Aubry: School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Kevin Pottie: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada

IJERPH, 2020, vol. 17, issue 21, 1-18

Abstract: Clinical practice guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health guideline. We completed a mixed-method study to identify determinants of equitable implementation of homeless health guidelines, focusing on the Grading of Recommendations Assessment, Development and Evaluation Feasibility, Acceptability, Cost, and Equity Survey (GRADE-FACE) health equity implementation outcomes. The study included a survey and framework analysis. Eighty-eight stakeholders, including practitioners and 16 persons with lived experience of homelessness, participated in the study. Most participants favourably rated the drafted recommendations’ priority status, feasibility, acceptability, cost, equity impact, and intent-to-implement. Qualitative analysis uncovered stakeholder concerns and perceptions regarding “fragmented services”. Practitioners were reluctant to care for persons with lived experience of homelessness, suggesting that associated social stigma serves as a barrier for this population to access healthcare. Participants called for improved “training of practitioners” to increase knowledge of patient needs and preferences. We identified several knowledge translation strategies that may improve implementation of guidelines for marginalized populations. Such strategies should be considered by other guideline development groups who aim to improve health outcomes in the context of limited and fragmented resources, stigma, and need for advocacy.

Keywords: guideline implementation; knowledge translation; determinants of evidence uptake; homelessness; GRADE FACE Survey; health equity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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