title: Application of standard treatment guidelines in rural community health centres, Timor-Leste.
abstract: OBJECTIVE
  To analyse nurses' and midwives' knowledge of and attitudes towards standard treatment guidelines (STGs), which were developed to help their practices at rural community health centres (CHCs) in Timor-Leste.
  
  
  METHODS
  Fifty-five nurses and midwives were individually interviewed. Data were analysed qualitatively using the Framework approach.
  
  
  RESULTS
  Overall, the standard treatments for acute respiratory tract infections, malaria and diarrhoea were well known by the respondents. Clinical nurses showed precise and detailed knowledge, especially for antibiotic use. The respondents were willing to use STGs and believed that they 'should' follow them. This feeling arose due to their self-awareness as frontline health workers and, at the same time, as peripheral civil servants. The changes brought about by the introduction of STGs were positively perceived. Three components of the change were observed: the concept, daily practice and perceived patient satisfaction. The respondents had previously felt a lack of confidence and hoped to improve their capacity as health care workers; they became confident in their practices by using STGs. Self-confidence was identified more clearly in the clinical nurse interviews. Few difficulties in using STGs were indicated, and the respondents suggested ways to deal with these difficulties.
  
  
  CONCLUSIONS
  By using the STGs, the nurses/midwives gained knowledge and self-confidence. The positive perception of the changes promoted further use of the STGs. Clinical nurse training positively influenced the knowledge of and attitudes towards the STGs. Few difficulties in applying STGs in daily practice were identified, which is contrary to previous studies that targeted physicians in the Western world. Development of STGs within a health policy framework was considered a key factor. The STGs exist across related policies and various programmes, which are interconnected. The Timor-Leste experience indicates the value of STGs for non-physician health care providers at the primary health care level.
authors: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. m.m.higuchi@med.nagoya-u.ac.jp
authors: Michiyo
authors: M
authors: Higuchi
authors: Junko
authors: J
authors: Okumura
authors: Atsuko
authors: A
authors: Aoyama
authors: Sri
authors: S
authors: Suryawati
authors: John
authors: J
authors: Porter
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D007214:Indonesia; D008297:Male; D008880:Midwifery; D009740:Nursing Staff; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D036301:Qualitative Research; D019035:Rural Health Services