Table 2 Adapting the guidelines using the ADAPTE process
Step | Activity | Result |
|---|---|---|
Phase I: set up | ||
1 | Establish a resource team | The research team (steering team), consisting of five members, was responsible for developing the terms of reference and compiling a list of potential members for the working group. Based on this list, the steering team extended invitations to individuals to join the group |
2 | Determine criteria for selection and select a topic using criteria | Postpartum was chosen as the focus because there is currently no national guideline for postpartum care in the country, and there are variations in the standards of care being provided that needed to be updated |
3 | Check if adaptation is feasible | Internationally, evidence-based guidelines for postpartum care were already in use, and there was considerable interest from the Ministry of Health, clinicians, and other stakeholders to develop similar guidelines |
4 | Identify necessary resources and skills | There was a high level of commitment among the members of the working group, and all the required areas of expertise were available, including obstetrics, reproductive health, midwifery, nurse, policy development, and neonatology |
5 | Complete tasks of the set-up phase | Members of the group decided to function as a working group coordinated by the Research Vice-Chancellor of the Faculty of Nursing and Midwifery |
6 | Write the plan for adaptation | A timeline for completion was established, additional resource persons to be included were identified. Task allocation among the members was also agreed upon |
Phase II adaptation | ||
7 | Determine and clarify the question | A PIPOH summary (Table 4) was prepared, and the areas of interest for postpartum standards of care were identified as assessment, prevention, screening, and education during the postpartum period |
8 | Search for guidelines and other relevantocumentation | The steering team searched for relevant postpartum guidelines |
9 | Screen the retrieved guidelines and record their characteristics and content | The recommendations of the guidelines for assesment, prevention, screening, and education of postpartum were reviewed, extracted, and compiled in summary tables |
10 | Eliminate a large number of the retrieved guidelines using the AGREE instrument | The rigor dimension of the AGREE II tool was utilized to eliminate guidelines that did not meet the stipulated criteria |
11 | Assess the quality of the guideline | The AGREE II instrument was used to scrutinize the quality of the guidelines |
12 | Assess the currency of the guideline | The retrieved guidelines were sufficiently up-to-date, and no new evidence was identified |
13 | Assess the content of the guideline | Recommendations for assessment, prevention, screening, and education were examined, and while there were some differences in the content of the guideline, they were not found to be contradictory |
14 | Assess the consistency of the guideline | There was clear consistency between the evidence from systematic reviews, the interpretation of the evidence, and the recommendations in the guidelines in all the areas of interest |
15 | Assess the acceptability and applicability of the recommendations | Care was taken to ensure the recommendations are not in conflict with other local guidelines and to appraise the implications of the guidelines on health service delivery |
16 | Review assessments | The results of the assessment of the guidelines were discussed in meetings of the working group |
17 | Select among guidelines and recommendations to create an adapted guideline | The WHO and NICE guidelines were the main guideline used because the recommendations compared well with the other guidelines and the practice-based recommendations were well-stated |
18 | Prepare a draft of the adapted guideline | The member of the research team compiled the results of the deliberations and wrote the draft guideline document |
Phase III finalization | ||
19 | Seek feedback on the draft guideline from those who would be using it | A draft of the guideline will be circulated for comments to the working group members, as well as obstetricians, reproductive health specialists, midwives, and other relevant stakeholders |
20 | Consult with endorsement bodies | The guidelines will be adopted by the Ministry of Health |
21 | Consult with developers of guidelines used as sources | Decisions about the recommendations will be made based on the available resources and facilities, as well as expert opinions regarding clinical benefits and localization capabilities |
22 | Acknowledge source documents | The key guidelines used for developing the local protocol will be cited |
23 | Plan for aftercare of the adapted guideline | A review date has been scheduled for five years from now, and monitoring indicators have been identified. The guidelines will be distributed in both electronic and print copies |
24 | Produce a final document of the guideline and other outputs | The following additional outputs will be produced (along with the guideline): posters and brochures for patient information, workshop slides for training health workers, Clinical Manual for Maternity Care, and quality assurance guidelines |