Supporting the implementation of health-system guidance at the national and sub-national level

Abstract

Health-system guidance (HSG) is expected to assist with making decisions about addressing problems or achieving goals in health systems. However, the implementation of HSG is challenging due to the complexity of health-system policymaking. Existing guideline implementation tools focus on clinical practice guidelines and might not be suitable for HSG. This dissertation aims to bridge this gap by developing a theoretical framework and a tool designed to support HSG implementation at both national and subnational levels. It achieves these objectives through three original scientific contributions. The first study uses a critical interpretive synthesis of the existing literature to develop a theoretical framework. This framework identifies facilitators of, barriers to, and strategies for supporting HSG implementation across six different levels: the political system, health system, community, organization, providers, and the public/patients. The second study employs a modified Delphi method to identify the components of an HSG implementation tool based on this framework. The third study adopts a formative evaluation study design to explore – through interviews with guideline implementers – whether, how, and why the HSG implementers will use the tool and how it can be refined, leading to the further development of the tool. These studies collectively offer theoretical, methodological and substantive insights into understanding the facilitators, barriers, and strategies crucial for the effective implementation of HSG. The developed HSG implementation framework and accompanying tool can be useful for supporting the implementation of HSG covering varied topics and in different contexts, including low-, middle- and high-income countries.