Developing a workbook to support the contextualisation of global health systems guidance: a case study identifying steps and critical factors for success in this process at WHO

Abstract

BackgroundGlobal guidance can help countries strengthen their health systems to deliver effective interventions to their populations. However, to have an impact, guidance needs to be contextualised or adapted to local settings; this process includes consideration of health system arrangements and political system factors. To date, methods to support contextualisation do not exist. In response, a workbook was designed to provide specific methods and strategies to enable the contextualisation of WHO’s ‘Optimizing health worker roles to improve maternal and newborn health’ (OptimizeMNH) guidance at the national or subnational level. The objective of this study was to describe the process of developing the workbook and identify key steps of the development process, barriers that arose and facilitators that helped overcome some of these barriers.MethodsA qualitative single case study design was carried out. Interviews, documents and a reflexive journal were used. Constant comparison and an edit-style of organisation were used during data analysis to develop concepts, themes, subthemes and relationships among them.ResultsThirteen interviews were conducted and 52 documents were reviewed. Three main steps were identified in the process of developing the workbook for health systems guidance contextualisation, namely (1) determining the need for and gaining approval to develop the workbook, (2) developing the workbook (taking on the task, creating the structure of the workbook, operationalising its components, undergoing approval processes and editing it), and (3) implementing the workbook both at the WHO level and at the national/subnational level.Five barriers and/or facilitators emerged relevant to each step, namely (1) having well-placed and credible champions, (2) creating and capitalising on opportunities, (3) finding the right language to engage various actors and obtain buy-in, (4) obtaining and maintaining meaningful buy-in, and (5) ensuring access to resources.ConclusionsUnderstanding the key steps and the critical factors involved in the process of developing the workbook could help in the planning of similar and other tools aimed to support the implementation of WHO guidance. A plan for dissemination and implementation needs to be addressed during the preparation of these tools.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0297-x) contains supplementary material, which is available to authorized users.

Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study

“…Healthcare avoidance has been reported worldwide [ 11 , 13 , 32 ]. Contextualising real or perceived healthcare access barriers and identifying factors related to avoiding healthcare can help healthcare systems, researchers, and policymakers find solutions to overcome these barriers [ 33 , 34 , 35 ].…”

Taking account of context in systematic reviews and guidelines considering a complexity perspective

“…The Oxford Implementation Index offers a rare example of a tool to help reviewers identify and extract contextual information associated with implementation from studies included in a systematic review 77. Other tools include implementation workbooks and worksheets 78 79. The ADAPTE toolkit80 highlights criteria for assessing whether a recommendation is applicable to a local context.…”

Defining and classifying public health systems: a critical interpretive synthesis

“…Originally developed as a taxonomy of health system topics to classify documents for Health Systems Evidence, this framework was chosen as the BFF theoretical framework because it is comprehensive (e.g. includes the essential components of WHO's health system building blocks [22]), easy to understand, and has been used in various international contexts for health systems and policy research and applied work, for example, to develop health systems guidance documents and to contextualise research for evidence-based decisionmaking in Peru and Uganda [28][29][30]. Codes were added inductively from the data and were linked into themes.…”