Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs

Nyawira Mwangi, Muchai Gachago, Michael Gichangi, Stephen Gichuhi, Kibata Githeko, Atieno Jalango, Jefitha Karimurio, Joseph Kibachio, Lawrence Muthami, Nancy Ngugi, Carmichael Nduri, Patrick Nyaga, Joseph Nyamori, Alain Nazaire Mbongo Zindamoyen, Covadonga Bascaran, Allen Foster

The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care.