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Abstract：
BACKGROUND: Low- and middle-income countries often lack the fiscal, infrastructural and human resources to conduct evidence-based research; similar constraints may also hinder the application of good clinical practice guidelines based on research findings from high-income countries. While the context of health organizations is increasingly recognized as an important consideration when such guidelines are implemented, there is a paucity of studies that have considered local contexts of resource-scarcity against recommended clinical guidelines.
METHODS: This paper sets out to explore the implementation of the NICE Guideline 11 on family interventions when working with persons with intellectual disability and challenging behavior by a group of psychologists employed in a government health facility in Cape Town, South Africa.
RESULTS: In the absence of evidence-based South African research, we argue that aspects of the guidelines, in particular those that informed our ethos and conceptual thinking, could be applied by clinical psychologists in a meaningful manner notwithstanding the relative scarcity of resources.
CONCLUSIONS: We have argued that where guidelines such as the NICE Guidelines do not apply contextually throughout, it remains important to retain the principles behind these guidelines in local contexts. Limitations of this study exist in that the data were drawn only from the clinical experience of authors. Some of the implications for future research in resource-constrained contexts such as ours are discussed. Smaller descriptive, qualitative studies are necessary to explore the contextual limitations and resource strengths that exist in low- and middle-income settings, and these studies should be more systematic than drawing only on the clinical experience of authors, as has been done in this study.
METHODS: This paper sets out to explore the implementation of the NICE Guideline 11 on family interventions when working with persons with intellectual disability and challenging behavior by a group of psychologists employed in a government health facility in Cape Town, South Africa.
RESULTS: In the absence of evidence-based South African research, we argue that aspects of the guidelines, in particular those that informed our ethos and conceptual thinking, could be applied by clinical psychologists in a meaningful manner notwithstanding the relative scarcity of resources.
CONCLUSIONS: We have argued that where guidelines such as the NICE Guidelines do not apply contextually throughout, it remains important to retain the principles behind these guidelines in local contexts. Limitations of this study exist in that the data were drawn only from the clinical experience of authors. Some of the implications for future research in resource-constrained contexts such as ours are discussed. Smaller descriptive, qualitative studies are necessary to explore the contextual limitations and resource strengths that exist in low- and middle-income settings, and these studies should be more systematic than drawing only on the clinical experience of authors, as has been done in this study.
摘要：
背景：中低收入国家往往缺乏财政，进行循证研究的基础设施和人力资源;类似的限制也可能阻碍基于高收入国家研究结果的良好临床实践指南的应用。虽然卫生组织的背景越来越被认为是实施此类准则时的一个重要考虑因素，缺乏针对推荐的临床指南考虑资源短缺的当地背景的研究.
方法：本文旨在探讨NICE指南11的实施情况，该指南涉及与智障人士和挑战行为者一起工作时，由一群在开普敦政府医疗机构工作的心理学家，南非。
结果：在缺乏基于证据的南非研究的情况下，我们认为指导方针的各个方面，特别是那些为我们的精神和概念思维提供信息的人，尽管资源相对稀缺，但临床心理学家仍可以以有意义的方式应用。
结论：我们认为，如果诸如NICE指南之类的指南在整个上下文中都不适用，在当地情况下保留这些准则背后的原则仍然很重要。这项研究的局限性在于数据仅来自作者的临床经验。讨论了在资源有限的情况下对未来研究的一些影响。较小的描述性，定性研究对于探索低收入和中等收入环境中存在的背景限制和资源优势是必要的，这些研究应该比仅仅依靠作者的临床经验更系统，正如在这项研究中所做的那样。
方法：本文旨在探讨NICE指南11的实施情况，该指南涉及与智障人士和挑战行为者一起工作时，由一群在开普敦政府医疗机构工作的心理学家，南非。
结果：在缺乏基于证据的南非研究的情况下，我们认为指导方针的各个方面，特别是那些为我们的精神和概念思维提供信息的人，尽管资源相对稀缺，但临床心理学家仍可以以有意义的方式应用。
结论：我们认为，如果诸如NICE指南之类的指南在整个上下文中都不适用，在当地情况下保留这些准则背后的原则仍然很重要。这项研究的局限性在于数据仅来自作者的临床经验。讨论了在资源有限的情况下对未来研究的一些影响。较小的描述性，定性研究对于探索低收入和中等收入环境中存在的背景限制和资源优势是必要的，这些研究应该比仅仅依靠作者的临床经验更系统，正如在这项研究中所做的那样。
