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Open AccessArticle

Determinants of Implementation of a Clinical Practice Guideline for Homeless Health

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Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
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Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
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School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
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Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Inner City Health Associates, Toronto, ON M5C 1K6, Canada
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Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
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Michael C. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
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Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Department of Family Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(21), 7938; https://doi.org/10.3390/ijerph17217938
Received: 25 September 2020 / Revised: 21 October 2020 / Accepted: 26 October 2020 / Published: 29 October 2020
(This article belongs to the Special Issue Health and Homelessness)
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. View Full-Text
Keywords: guideline implementation; knowledge translation; determinants of evidence uptake; homelessness; GRADE FACE Survey; health equity guideline implementation; knowledge translation; determinants of evidence uptake; homelessness; GRADE FACE Survey; health equity
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MDPI and ACS Style

Magwood, O.; Hanemaayer, A.; Saad, A.; Salvalaggio, G.; Bloch, G.; Moledina, A.; Pinto, N.; Ziha, L.; Geurguis, M.; Aliferis, A.; Kpade, V.; Arya, N.; Aubry, T.; Pottie, K. Determinants of Implementation of a Clinical Practice Guideline for Homeless Health. Int. J. Environ. Res. Public Health 2020, 17, 7938. https://doi.org/10.3390/ijerph17217938

AMA Style

Magwood O, Hanemaayer A, Saad A, Salvalaggio G, Bloch G, Moledina A, Pinto N, Ziha L, Geurguis M, Aliferis A, Kpade V, Arya N, Aubry T, Pottie K. Determinants of Implementation of a Clinical Practice Guideline for Homeless Health. International Journal of Environmental Research and Public Health. 2020; 17(21):7938. https://doi.org/10.3390/ijerph17217938

Chicago/Turabian Style

Magwood, Olivia; Hanemaayer, Amanda; Saad, Ammar; Salvalaggio, Ginetta; Bloch, Gary; Moledina, Aliza; Pinto, Nicole; Ziha, Layla; Geurguis, Michael; Aliferis, Alexandra; Kpade, Victoire; Arya, Neil; Aubry, Tim; Pottie, Kevin. 2020. "Determinants of Implementation of a Clinical Practice Guideline for Homeless Health" Int. J. Environ. Res. Public Health 17, no. 21: 7938. https://doi.org/10.3390/ijerph17217938

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