Ambivalence of primary health care professionals towards the South Africanguidelines for hypertension and diabetes

Background. Consensus-derived guidelines for hypertension and diabetes mana gement were introduced by the National Department of Health to improve qual ity of care. However, the incorporation of guidelines into clinical practic e is largely dependent on the attitudes of health professionals. Objective. To audit the responses and examine the attitudes of health profe ssionals in primary care towards the diabetes and hypertension care guideli nes. Design Qualitative focus group, in-depth discussions and clinic observation s. Setting. Four community health centres (CHCs) in the Western Cafe. Subjects. Fifteen doctors and 10 professional nurses. Methods. The responses of health professionals to the guidelines were audit ed. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on th ese themes were conducted at 3 other CHCs. Clinic consultations were observ ed to validate the responses. Results. The guidelines were not systematically implemented at local CHCs a nd individual doctors consulted the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines, includin g the consultation process by which the guidelines were developed, time con straints, scepticism about durability of the guidelines, conflict with loca l 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 ba rriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.