临床实践指南可以改善边缘化人群的临床和社会护理,从而改善健康公平。这项研究的目的是从无家可归的健康指南的患者和从业者利益相关者的角度确定指南实施的决定因素。我们完成了一项混合方法研究,以确定公平实施无家可归者健康指南的决定因素,注重建议评估的分级,开发和可行性评估,可接受性,成本,和公平调查(GRADE-FACE)健康公平实施结果。该研究包括调查和框架分析。88个利益相关者,包括从业人员和16名有无家可归经历的人,参与研究。大多数与会者对起草的建议的优先地位给予了好评,可行性,可接受性,成本,股权影响,和实施意图。定性分析揭示了利益相关者对“碎片化服务”的担忧和看法。从业者不愿照顾有无家可归经历的人,这表明相关的社会污名是该人群获得医疗保健的障碍。参与者呼吁改善“从业人员培训”,以增加对患者需求和偏好的了解。我们确定了几种知识翻译策略,可以改善边缘化人群指南的实施。其他准则制定小组应考虑这些战略,这些小组旨在在资源有限和分散的情况下改善健康结果,污名,需要宣传。
Clinical practice
guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of
guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health
guideline. We completed a mixed-method study to identify determinants of equitable implementation of homeless health guidelines, focusing on the Grading of Recommendations Assessment, Development and Evaluation Feasibility, Acceptability, Cost, and Equity Survey (GRADE-FACE) health equity implementation outcomes. The study included a survey and framework analysis. Eighty-eight stakeholders, including practitioners and 16 persons with lived experience of homelessness, participated in the study. Most participants favourably rated the drafted recommendations\' priority status, feasibility, acceptability, cost, equity impact, and intent-to-implement. Qualitative analysis uncovered stakeholder concerns and perceptions regarding \"fragmented services\". Practitioners were reluctant to care for persons with lived experience of homelessness, suggesting that associated social stigma serves as a barrier for this population to access healthcare. Participants called for improved \"training of practitioners\" to increase knowledge of patient needs and preferences. We identified several knowledge translation strategies that may improve implementation of
guidelines for marginalized populations. Such strategies should be considered by other
guideline development groups who aim to improve health outcomes in the context of limited and fragmented resources, stigma, and need for advocacy.