Propuesta de acciones para llevar a cabo la integración de la actividad de

6.4.1

Introduction

The development of the guideline took place over two meetings in which the participants were presented with the systematic review evidence of the clinical questions, which they discussed and from which they distilled the recommendations.

This section introduces the findings relating to the participants experience of developing the guideline and focuses.

6.4.2

The experience of participation

Overall positivity was expressed by the participants towards the experience of developing a guideline using this process. This was attributed to working with a clear structure and infrastructure and having the work reviewed and presented by an external organisation. It was noted that undertaking the work externally, alleviated the pressure of completing the work internally as this type of work is normally voluntary and can take a long time to complete. Working with another organisation in this way was also expressed as requiring trust as they had not worked with the organisation before. It was suggested that this may have been easier if more time had been given to develop a relationship between the developers and the guideline group.

“I think it was quite a very positive experience. I’ve personally been involved in guideline development previously em ,but without the ,eh, the infrastructure that was afforded to us

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this time round. So the fact that women who is quite experienced in doing this sort of things on previous occasions and is quite well renowned and good reputation in that regard does the fieldwork in doing the systematic and meta-analysis. I think that was a quite positive experience.” (IA09)

“the positive thing is its very interesting and its also a pleasure being part of a group like yours.” (IA04)

Participants expressed mixed views about the information session that was held during the first meeting. Some participants stated that it was pitched too low and reported that they found it insulting whilst others found it very helpful and informative.

Disappointment and frustration was voiced by participants about the number of people who attended the second session in which the recommendations for the guideline were formulated. Annoyance was expressed that not all group members understood the importance of attending. Participants noted how the lack of attendees affected discussion as those needed for certain aspects were not present and this was perceived as affecting decision making. They questioned whether if there had been a different complement of people, whether the recommendations would have differed. These factors were mitigated by the circulation of recommendations to all involved stakeholders.

“The good is that something is being done you know.” (IA04)

Responses indicated that the representation on the guideline group was good, however it was noted that primary care should have been involved.

6.4.3

Learning process

Participants acknowledged that they had acquired a greater understanding of the amount of work required to undertake the systematic reviews. The way in which the work was presented was congratulated, with participants stating that they found it clear and helpful in aiding understanding, principally the visual representation of the results of the

systematic reviews. This is particularly important as there was a large volume of

information that needed to be understood in a short time period. It was reported that the opportunity to discuss the systematic reviews in a constructive way leading to the

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“When you read is one thing, but when you discuss, it’s another thing and you ask the why, the why, it’s also, you know questions were coming up, but why sort of this. I think it’s the better way.” (IA06)

Participants explained that they had joined the group with the expectation that they knew what they were going to recommend. Yet, providing the opportunity to discuss the evidence presented resulted in a change in perception and a reassessment of the recommendations, creating recommendations based on the evidence. A sense of pride was exhibited that they had been able to influence the direction of the recommendations and the process undertaken had been successful. Recognition of the active role

participants had in data interpretation was made and an acknowledgement that they had derived similar, if not the same interpretations of the data as the guideline group in the UK.

“We did influence I think because we sort of decided which areas we wanted to look at and then we were involved in the interpretation of the data”. (IA09)

The analysis revealed that there was no change in the participants views to what evidence based healthcare meant to them. If anything, it consolidated these views but the process resulted in them being more open minded about how evidence could be used and questioned. A process of re-evaluation as to what makes acceptable evidence, was reported by some whilst others identified an improved understanding of research papers.

“I was surprised about, I mean I knew it but when you actually see so many studies that are poor to maybe moderate, you know when they are all listed one after the other, it really hits home how badly these things are done where weight loss is concerned.” (IA03)

6.4.4

Summary

Feedback regarding the experience of developing the guideline was positive overall. Enthusiasm for the project was expressed by all and observed in all situations. A suggestion for this sense of enthusiasm was that this was a key piece of work, being completed by another party. Once consideration of the workload and demands on the individuals and their service, this was of great assistance to them. There was disappointment in regards to the numbers that were present for the last meeting and a sense of a lack of engagement by some stakeholders. To ensure they were kept in the developmental loop, the guideline in draft form was sent to all for comment. This also worked as a way of keeping up the momentum of development and hopefully implementation.

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