Ambivalence of primary health care professionals towards the South African guidelines for hypertension and diabetes.
BACKGROUND
Consensus-derived guidelines for hypertension and diabetes management were introduced by the National Department of Health to improve quality of care. However, the incorporation of guidelines into clinical practice is largely dependent on the attitudes of health professionals.


OBJECTIVE
To audit the responses and examine the attitudes of health professionals in primary care towards the diabetes and hypertension care guidelines.


METHODS
Qualitative focus group, in-depth discussions and clinic observations.


METHODS
Four community health centres (CHCs) in the Western Cape.


METHODS
Fifteen doctors and 10 professional nurses.


METHODS
The responses of health professionals to the guidelines were audited. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on these themes were conducted at 3 other CHCs. Clinic consultations were observed to validate the responses.


RESULTS
The guidelines were not systematically implemented at local CHCs and individual doctors consulted the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines, including the consultation process by which the guidelines were developed, time constraints, scepticism about durability of the guidelines, conflict with local practices, health system problems, and patient beliefs.


CONCLUSIONS
The usefulness of passive dissemination of guidelines to health professionals in primary care should be reviewed as several attitudinal barriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.
Daniels
A
A
Chronic Diseases of Lifestyle Programme, Medical Research Council, Tygerberg, W Cape.
Biesma
R
R
Otten
J
J
Levitt
N S
NS
Steyn
K
K
Martell
R
R
Dick
J
J
D001291:Attitude of Health Personnel; D003151:Community Health Centers; D003920:Diabetes Mellitus / Q000517:prevention & control*; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D009726:Nurses; D010342:Patient Acceptance of Health Care; D010820:Physicians; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors; D013019:South Africa; D013997:Time Factors