| Theory/concept | Assumption | Application in the development and dissemination of CPGs | |
| Behavioural change model28 | Moving through the stages of readiness to change requires changing knowledge and attitudes, encouraging positive beliefs about one’s ability to enact change, and adapting the environment where changes take place | Knowledge transfer in didactic sessions, emphasis on optimising basic, achievable forms of care through repeated interactive learning sessions. Sharing the results and processes of hospital surveys to allow reflection on current practice and indicate the need for change | |
| Adult learning theories29 | Adults change practice by learning rather than being taught. | Active participatory learning, small group interactive sessions, multi-method training | |
| Social influence theory27 44 | An individual’s belief and behaviour are influenced by persons in their social network and society at large. | Involvement of local experts in development of the CPGs. Weight of evidence. Institutional/governmental endorsement and dissemination of guidelines. Use of facilitators with credible backgrounds | |
| Diffusion of innovation theory23 45–47 | Individuals adopt change at different speeds. Innovators | Institutional dissemination of guidelines. Mass training to create a corps of people | |
| and early adopters will encourage others in changing | supporting new practices | ||
| practice. Some features of innovation modify its | Simplified guidelines with clear and definite messages, repeated series of skill practice and | ||
| adoption, including complexity, advantage over existing practices | case scenarios. New guidelines were adapted from existing guidelines (ETAT, PALS, IMCI, | ||
| and procedures, compatibility with guidelines in use, | national HIV and malaria guidelines). | ||
| “trialability”, and observability of results before | Introduction of time-saving job aides | ||
| adopting the innovation | |||
| Health education model25 33 48 | Behaviour change depends on predisposing, enabling | Predisposing strategies: lectures, emphasis on best practice, credible lecturers and CPGs | |
| and reinforcing factors. Predisposing factors are less | based on available resources | ||
| likely to change physicians’ behaviour compared to | Enabling strategies: job aides, practice of skills | ||
| enabling and reinforcing elements, but behaviour | Reinforcing strategies: immediate feedback on personal performance, audit/reflection on | ||
| change cannot take place without addressing gaps | current practice, end of course test and evaluation, hospital survey and feedback | ||
| in knowledge and skill. | |||
| Reflection26 | Reflection is integral to knowledge translation and enhances the capacity to visualise new realities and outcomes | Problem based audit, hospital survey and feedback, small group learning, role play, case scenarios with team of hospital colleagues emphasising successful performance and post course evaluation |
CPG, clinical practice guideline; ETAT, emergency triage, assessment and treatment.