This chapter identifies the many channels via which the guideline will be disseminated, and analyses the anticipated impacts of the guideline.
Dissemination of the Guideline:
This guideline will be available for download and also as a printed publication. Dissemination plans also include technical meetings, the development of evidence briefs, and workshops and briefings with global and regional stakeholder groups.
Applicability of the Guideline:
This section describes the potential barriers to implementation as well as plans for monitoring and evaluation of the guideline impacts.
Updating the Guideline:
The rapidly evolving nature of self-care interventions calls for a continuous review of the literature. An update to this guideline will likely be required within 18–24 months of dissemination of this edition.
“Effective implementation of the recommendations and good practice statements in this guideline will likely require reorganization of care and redistribution of health-care resources, particularly in low- and middle-income countries.”
7.1. Dissemination
This guideline will be available online for download and also as a printed publication. Online versions will be available via the website of the WHO Department of Reproductive Health and Research, and through the WHO Reproductive Health Library (RHL).1 Print versions will be distributed to WHO regional and country offices, ministries of health, WHO collaborating centres, nongovernmental organization partners and professional associations. Technical meetings will be held jointly with the Department and the regional offices to share the recommendations and derivative products, which will include implementation tools for the new recommendations and good practice statements. Two sets of evidence briefs will also be developed – one set for policy-makers and programme managers and the other for health-care professionals – highlighting the recommendations and implementation-related contextual issues.
The dissemination plans also include workshops and briefings with different stakeholders at the global and regional levels. It is expected that detailed plans for development of the evidence briefs and implementation tools, as well as for dissemination and implementation of the guideline, will be formulated in collaboration with implementing partners, national stakeholders and civil society, and will allow for derivative products to be tailored to the needs in different national contexts.
The executive summary and recommendations from this publication will be translated into the six United Nations languages for dissemination through the WHO regional offices and during meetings organized or attended by staff of relevant WHO departments.
The guideline will be launched on the website of the WHO Department of Reproductive Health and Research and in “HRP News”, the monthly electronic newsletter.2 HRP News currently has over 3000 subscribers including clinicians, programme managers, policy-makers and health-service users worldwide. This guideline will also be shared through several knowledge-sharing platforms, including the Implementing Best Practices (IBP) initiative,3 and on the website of the Interagency Working Group on SRH & HIV Linkages;4 both of these groups reach key partners working in the field of sexual and reproductive health and rights (SRHR). In addition, the systematic and literature reviews that were conducted for the development of this guideline have been published (see Annex 7), in compliance with WHO’s open access and copyright policies.
To increase the dissemination of WHO guidelines on SRHR, a search function with the ability to search the database of WHO guidelines and recommendations has been created and recently launched by the Department. The recommendations of this guideline will be made available via this new search function.5
7.2. Applicability
7.2.1. Anticipated impact of the guideline
Effective implementation of the recommendations and good practice statements in this guideline will likely require reorganization of care and redistribution of health-care resources, particularly in low- and middle-income countries (LMICs). The potential barriers to implementation include:
lack of human resources with the necessary expertise and skills to implement, supervise and support recommended practices, including client counselling;
lack of infrastructure to support the intervention;
lack of physical space to conduct individual or group counselling;
lack of quality physical resources, such as equipment, test kits, supplies, medicines and nutritional supplements;
lack of effective referral mechanisms, integrated services and care pathways for people who may require additional care;
lack of understanding of the value of newly recommended interventions among health-care providers and health system managers;
lack of health management information systems (e.g. client cards, registers) designed to document and monitor recommended practices;
lack of laws, policies and regulations to support safe and effective implementation;
need for refinancing and re-budgeting to address the above-mentioned shortcomings.
Given the potential barriers noted above, a phased approach to adoption, adaptation and implementation of the guideline recommendations may be required. Various strategies will be applied to ensure that the people-centred approach and key principles that underpin this guideline are operationalized, and to address these barriers and facilitate implementation.
7.2.2. Monitoring and evaluating the impact of the guideline
It is critical that monitoring and evaluation systems are practical, not overly complicated, and collect information that is current, useful and can be readily applied. The implementation and impact of these recommendations will be monitored at the health service, regional and country levels, based on existing indicators. However, given the private space in which self-care is practised, alternative ways to assess the impact of the interventions need to be developed. Emphasis on use and uptake by vulnerable populations means that there will need to be meaningful engagement of affected communities.
In collaboration with the WHO Department of Health Metrics and Measurement (which leads the data collection and analysis for the WHO Global Health Observatory), the Department of Reproductive Health and Research will monitor and evaluate country- and regional-level data on health seeking behaviours and implementation of selected self-care interventions. These data will allow for a better understanding of the short-to-medium-term impact of self-care interventions on national policies of individual WHO Member States.
The WHO 13th General Programme of Work (GPW13) Impact Framework will also be used to monitor self-care interventions (1).
7.3. Updating the Guideline
This guideline uses a “living guideline” format, allowing for review of new research evidence to ensure that it can be brought to the GDG for review (see Chapter 1, section 1.4.4). This is the first version of this guideline; future updates will include topics, recommendations and good practice statements relevant to SRHR and noncommunicable diseases (NCDs), as well as other areas of health. A virtual GDG will be convened for formulating recommendations based on evidence tables prepared for the additional priority questions, followed by the preparation and release of the new version.
In accordance with the concept of WHO’s GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge),6 which employs a systematic and continuous process of identifying and bridging evidence gaps following guideline implementation, this guideline will be updated as new evidence becomes available.
The rapidly evolving nature of self-care interventions calls for a continuous review of the literature. An update to this guideline will likely be required within 18–24 months of dissemination of this edition, to accommodate either new evidence on existing recommendations or to develop new recommendations based on emerging evidence, including on new SRHR self-care interventions that may not have been available or identified during the discussions for the current version. The WHO Guideline Steering Group will continue to follow the research developments in self-care for SRHR, and additional colleagues from relevant departments will be brought in to expand the scope to NCDs and possibly other areas. An example of a new SRHR-related self-care recommendation might be the self-insertion of an intravaginal ring for HIV prevention and contraception. Several multipurpose technologies are in various stages of research and development, but are not yet available on the market. There are many areas for which no evidence was found or that are supported by low-quality evidence, and in these cases new recommendations or a change in the published recommendation, respectively, may be warranted. Any concern about the validity of a recommendation will be communicated promptly following approval from the WHO Guidelines Review Committee (GRC) of rapid guidance, and plans will be made to update the recommendation as needed in the next version(s) of the guideline.
All technical products developed during the process of developing this guideline – including full reports of systematic reviews, corresponding search strategies and dates of searches – will be archived for future reference and use. Where there are concerns about the validity of a recommendation based on new evidence, the systematic review addressing the primary question will be updated. To update the review, the search strategy used for the initial review will be applied. Any new questions identified following the scoping exercise will undergo a similar process of evidence retrieval, synthesis and application of the GRADE approach in accordance with the standards in the WHO handbook for guideline development (2014) (2).
The guideline development process identified a fair number of knowledge gaps, which are highlighted in Chapter 6 (Table 6.1). WHO aims to develop further guidance for SRHR and other health areas that would be likely to promote equity, be feasible to implement, and contribute to improvements in self-care, so that the appropriate recommendations can be included in future versions of this guideline, and can be adopted and implemented by countries and programmes.
References for Chapter 7
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