Assessing the Policy-to-Practice Gap in the Implementation of Nutritional Guidelines for Diabetes and Hypertension in Region 3, Guyana: A Mixed-Methods Study Using the Social Ecological Model, RE-AIM and Knowledge-to-Action Frameworks
Abstract:
Diabetes and hypertension remain major public health challenges in Guyana. The extent to which evidence-based nutrition guidelines are translated into routine clinical practice remains insufficiently understood. This study assessed the policy-to-practice gap in the implementation of nutrition guidelines for diabetes and hypertension in Region 3, Guyana. A convergent mixed-methods implementation study was conducted across four public health facilities. Quantitative data were obtained from 2,745 patient records, facility audits and healthcare provider surveys, while qualitative data were collected through focus group discussions, community outreach activities, and key informant interviews. The study was guided by the Social Ecological Model (SEM), the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, and the Knowledge-to-Action (KTA) framework. Although all facilities demonstrated moderate policy readiness (60%), overall implementation fidelity remained low, with a mean implementation score of 40%. Patients frequently reported receiving nutrition counselling; however, documentation of counseling within clinical records was limited. Healthcare providers demonstrated moderate knowledge of nutrition recommendations, but implementation practices were comparatively weaker, with training deficiencies and limited educational resources identified as major provider barriers. Patient awareness was positively associated with reported dietary practices, although elevated blood pressure and random blood sugar levels remained common. Cost and affordability (63.5%) and cultural food norms (19.7%) were the most frequently reported barriers to implementing recommended dietary practices. The combined application of the SEM, RE-AIM, and KTA frameworks identified implementation gaps across organizational, provider, community, and policy levels. A substantial policy-to-practice gap exists in the implementation of nutrition guidelines for diabetes and hypertension in Region 3, Guyana. Strengthening provider capacity, implementation monitoring, clinical documentation and culturally responsive, affordable nutrition interventions are essential to improve implementation fidelity, support knowledge translation and enhance the sustainability of nutrition services within primary healthcare.References:
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