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Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria

Wood, Caroline E; Luedtke, Susanne; Musah, Anwar; Bammeke, Funmi; Mutiu, Bamidele; Ojewola, Rufus; Bankole, Olufemi; ... Kostkova, Patty; + view all (2022) Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria. JAC-Antimicrobial Resistance , 4 (2) , Article dlac044. 10.1093/jacamr/dlac044. Green open access

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Abstract

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.

Type: Article
Title: Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/jacamr/dlac044
Publisher version: https://doi.org/10.1093/jacamr/dlac044
Language: English
Additional information: © The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > Dept of Geography
UCL > Provost and Vice Provost Offices > UCL SLASH
URI: https://discovery.ucl.ac.uk/id/eprint/10147380
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