The Dilemmas and Opportunities of Co‐Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania
| dc.contributor.author | Mbekenga,Columba K. | |
| dc.date.accessioned | 2025-04-03T11:30:21Z | |
| dc.date.available | 2025-04-03T11:30:21Z | |
| dc.date.issued | 2024-10-24 | |
| dc.description.abstract | Introduction: Healthcare providers' role in co‐creating health interventions and implementation strategies has evolved sig- nificantly, and yet, there is little documentation of this from low‐resource settings. This study aims to share the dilemmas of engaging healthcare providers in co‐creating locally adapted clinical guidelines for maternity facilities in Dar es Salaam, Tanzania, and strategies used to address them. Methods: An ethnographic study explored the co‐creation of locally adapted clinical guidelines for childbirth care within five maternity facilities in Dar es Salaam. Participant observations were conducted during 11 co‐creation workshops. Six in‐depth interviews explored participant experiences. Data were analyzed using Attride‐Stirling's thematic network analysis framework. Results: The analysis revealed four themes representing dilemmas in the co‐creation process and strategies to improve co‐ creation: (i) navigating diverse contexts: adapting a single set of guidelines to various, diverse facilities was challenging; this was addressed through engaging in dialogue and flexibility while adjusting care practices. (ii) Competing knowledge systems and sources: differing knowledge sources between researchers and healthcare providers challenged discussions on recommended practices. However, validating scientific recommendations with practical care experience in this context helped bridge this gap. (iii) Fostering meaningful participation: participation was time‐consuming for some. However, early stakeholder engagement and facility‐led participant selection facilitated the meaningful involvement of healthcare providers. (iv) Power imbalances: power dynamics influenced the co‐creation process; involving stakeholders in planning and co‐facilitating workshops helped mitigate these imbalances and encourage more equal participation. Conclusion: Navigating contextual variation, differences in knowledge systems, meaningful participation and power dynamics were key challenges in the co‐creation process. However, reflexivity, open and honest dialogue with stakeholders and early engagement enhanced the co‐creation process. Co‐creating locally adapted clinical guidelines with frontline healthcare workers and scientific experts is essential for feasibility and safety. Further research is needed to explore context specificity, decision‐ making and the efficacy of co‐creation in low‐resource settings. | |
| dc.identifier.citation | Osaki, H., Skovdal, M., Sørensen, J.B., Maaløe, N., Housseine, N., Dmello, B.S. and Mbekenga, C., 2024. The Dilemmas and Opportunities of Co‐Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania. Health Expectations, 27(5), p.e70073. | |
| dc.identifier.other | https://doi.org/10.1111/hex.70073 | |
| dc.identifier.uri | http://kuir.ku.ac.tz:4000/handle/123456789/1498 | |
| dc.language.iso | en | |
| dc.publisher | Health Expectations | |
| dc.subject | Childbirth care | |
| dc.subject | Clinical guidelines | |
| dc.subject | Tanzania | |
| dc.title | The Dilemmas and Opportunities of Co‐Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania | |
| dc.type | Article |