Table 1 Summary of different study phases for the contextualisation process

Research design

Exploratory, descriptive, qualitative study

Systematic review

Consensus study

Small scale survey

Focus

The lived experience of patients with CMSP and the primary health care received.

Healthcare practitioners’ perspectives about the primary health care of patients with CMSP.

Identification and appraisal of available CPGs and associated clinical recommendations for the primary health care of adults with CMSP.

Evaluation and endorsement of the clinical recommendations sourced during study phase 2.

Development of context and practice points for implementation of the recommendations.

Stakeholders evaluated the applicability and acceptability of the draft CPG.

Setting

Three diverse community health centres/clinics in the public healthcare sector.

Guidelines specific to primary healthcare settings.

The local primary healthcare context.

The local primary healthcare context.

Sample eligibility

Adults with CMSP who presented for care at the indicated clinics.

Healthcare practitioners involved in the management of adults with CMSP at the clinics.

CPGs on the topic that was available in full text and published during the timeframe January 2000 to May 2015.

Local healthcare experts who had practical experience and interest in CMSP.

Practitioners from diverse settings (government health subdivisions, academic institutions and private practitioners).

A group of potential end-users such as policy makers, representatives from professional organisations and clinicians.

Procedures/Instrumentation

Semi-structured individual interviews.

Participants completed a sociodemographic questionnaire. Patient participants completed a questionnaire on pain location and intensity, the pain disability index and the Kessler psychological distress scale.

Systematic search and selection.

Quality appraisal using the AGREE II instrument.

Data extraction into a recommendations matrix.

Online Delphi survey in two rounds, interspaced with a consensus meeting.

Delphi surveys: the panel evaluated and rated each recommendation for its applicability for the SA context.

Consensus meeting: the panel members worked in focused groups to generate context points, using the information obtained from study phase 1.

Participants appraised a short form of the draft CPG using a questionnaire.

Feedback on the following were invited: The endorsed recommendations; context points; the proposed patient pathway; acceptability for patients and staff, healthcare resources, training required and format.

Data analysis

Inductive, thematic, content analysis.

The questionnaire data were analysed and conveyed as frequencies, proportions and percentages.

Methodological quality: Summary of domain scores obtained for AGREE II using the principles provided in the user manual.

Content analysis comprising of: recommendation content, wording, underpinning body of evidence and references.

Delphi survey: explicit aggregation using the median as a measure of central tendency and the interquartile range (IQR) for the level of dispersion.

Consensus meeting: documented context points were categorised and thematically summarised.

Ordinal data were summarised using the median and IQR, while interval data were summarised using the mean and standard deviation.

Main findings

Framework of contextual factors that influence pain management in this context.

Barriers to and facilitators of pain management.

A set of multidisciplinary clinical recommendations as propositions for inclusion in the CPG.

A core set of recommendations were endorsed by the panel.

Context points for implementation of the recommendations.

Confirmation of applicability and acceptability of recommendations in the intended context. Identification of key topics that need further exploration.

Use of information in the study

Used in study phase 3 to inform decision making and to develop context points.

The clinical recommendations formed the foundation of study phases 3 and 4.

The endorsed recommendations were included in the draft guideline and used during study phase 4.

Refining the CPG.