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Determinants of Implementation of a Clinical Practice Guideline for Homeless Health

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  • Olivia Magwood

    (Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
    C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada)

  • Amanda Hanemaayer

    (C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
    Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada)

  • Ammar Saad

    (C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

  • Ginetta Salvalaggio

    (Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada)

  • Gary Bloch

    (Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
    Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
    Inner City Health Associates, Toronto, ON M5C 1K6, Canada)

  • Aliza Moledina

    (Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

  • Nicole Pinto

    (Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada)

  • Layla Ziha

    (C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
    Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

  • Michael Geurguis

    (Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada)

  • Alexandra Aliferis

    (Michael C. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada)

  • Victoire Kpade

    (Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada)

  • Neil Arya

    (Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
    Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada)

  • Tim Aubry

    (School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

  • Kevin Pottie

    (C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
    Department of Family Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

Abstract

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.

Suggested Citation

  • Olivia Magwood & Amanda Hanemaayer & Ammar Saad & Ginetta Salvalaggio & Gary Bloch & Aliza Moledina & Nicole Pinto & Layla Ziha & Michael Geurguis & Alexandra Aliferis & Victoire Kpade & Neil Arya & T, 2020. "Determinants of Implementation of a Clinical Practice Guideline for Homeless Health," IJERPH, MDPI, vol. 17(21), pages 1-18, October.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:21:p:7938-:d:436767
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    References listed on IDEAS

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    1. David Ponka & Eric Agbata & Claire Kendall & Vicky Stergiopoulos & Oreen Mendonca & Olivia Magwood & Ammar Saad & Bonnie Larson & Annie Huiru Sun & Neil Arya & Terry Hannigan & Kednapa Thavorn & Anne , 2020. "The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-21, April.
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    Cited by:

    1. Kate Frazer & Thilo Kroll, 2022. "Understanding and Tackling the Complex Challenges of Homelessness and Health," IJERPH, MDPI, vol. 19(6), pages 1-3, March.
    2. Coline van Everdingen & Peter Bob Peerenboom & Koos van der Velden & Philippe Delespaul, 2023. "Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity," IJERPH, MDPI, vol. 20(3), pages 1-16, January.

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