Translation of clinical practice guidelines on lifestyle behavior in a psychiatric setting. A discourse analytical case study

Abstract

Introduction Implementation of clinical practice guidelines (CPGs) can be constrained by diverging guideline interpretations, leading to a discrepancy between the intended clinical practice and the clinical practice implemented. We examine how CPGs on lifestyle behavior for psychiatric inpatients are translated into clinical daily practice, and how this was affected by discourses surrounding the stakeholders. Methods We conducted a comparative case study within two psychiatric wards in Denmark, wherein a clinical practice guideline (CPG) addressing lifestyle behavior was implemented. The objective of the CPG was to strategically intervene in the prevalence of unhealthy lifestyle practices among inpatients. Critical discourse analysis and a perspective of translation formed the theoretical framework. We collected empirical material at two stakeholder levels; the CPG authors and clinicians. This included documents related to the CPGs, field observations and two focus group interviews with clinicians. Results The CPG were composed within a system-centered discourse where lifestyle intervention was considered relevant for all inpatients. The clinicians translated the CPGs within a person-centered discourse and a prioritization discourse, focusing on individual factors such as the patients' own wishes, surplus energy, and the status of the psychiatric treatment. Conclusion The findings show that implementation of guidelines in their original form cannot be anticipated, but will constitute translation based on social structures and their discourses. Unawareness of this phenomenon called translation may affect implementation and should be considered when CPGs are developed and launched. Future research should explore how discourses and social processes among patients influences implementation of CPGs.