ambivalence among primary health care professionals to the South African guidelines for hypertension and diabetes.
Daniels AR, Biesma R, Otten J, Levitt NS, Steyn K*, Martell R, Dick J.
S Afr Med J 2000; in press.
Abstract

Background
Consensus derived guidelines for hypertension and diabetes management were introduced by the National Department of Health to improve the quality of care. However, the incorporation of guidelines into clinical practice is largely dependent on the attitudes of health professionals.

Objective
To audit the responses and examine the attitudes of health professionals in primary care to the diabetes and hypertension care guidelines.

Design
Qualitative focus group, in-depth discussions and clinic observations.

Setting
Four community health centres (CHCs) in the Western Cape.

Subjects
Fifteen doctors and 10 professional nurses.

Methods
The responses of health professionals to the guidelines were audited. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on these themes were conducted at three other CHCs. Clinic consultations were observed to validate the responses.

Results
The guidelines were not systematically implemented at local CHCs and individual doctors consult the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines including the consultation process by which the guidelines were developed, time constraints, scepticism about durability of the guidelines, conflict with local work practices, health system problems, and patient beliefs.

Conclusion
The usefulness of passive dissemination of guidelines to health professionals in primary care should be reviewed as several attitudinal barriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.

Keywords: Diabetes, Hypertension, Practice Guidelines, Attitude of Health Personnel