BACKGROUND Properly implemented evidence-based clinical and public health guidelines can improve patient outcomes. WHO has been a major contributor to guideline development, publishing more than 250 guidelines on various topics since 2008. However, well-developed guidelines can only be effective if they are adequately and appropriately implemented. Herein, we aimed to explore whether and how WHO guidelines are implemented in local contexts to inform the success of future guideline implementation. METHODS Seventeen interviews were carried out between March 2018 and December 2018 with WHO guideline developers, headquarter staff, and regional and country office staff. Participants were purposely sampled from a variety of WHO guidelines and snowball sampling was used to identify regional and country office staff. The deidentified transcripts were analysed through three phases of coding, using grounded theory as the analytic approach. RESULTS WHO guidelines played a variety of roles in the work of WHO at all levels. WHO officers and local government officials used WHO guidelines to influence health policy. We categorised the uses of guidelines as (1) directly changing policy, (2) justifying policy change, (3) engaging stakeholders, (4) being guarantors of legitimacy, (5) being advocacy tools, and (6) intertwining with WHO's various roles. Participants refuted the perception of the guidelines as mere lists of technical recommendations that needed to be implemented in different contexts. We found that the existence, quality and credibility, rather than the content of the guidelines, are the keys to health policy change initiatives in different local contexts. CONCLUSIONS Used as a guarantor of legitimacy by policy-makers, WHO guidelines can be better positioned to influence health policy and practice change. Understanding the various roles of guidelines can help WHO developers package guidelines to optimise their effective implementation. ETHICS This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

中文翻译：

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健康促进者、倡导者、合法化者——世卫组织指南的多种作用：定性研究。

背景 正确实施的循证临床和公共卫生指南可以改善患者的预后。WHO 一直是指南制定的主要贡献者，自 2008 年以来发布了 250 多份关于各种主题的指南。但是，完善的指南只有在得到充分和适当实施的情况下才能有效。在此，我们旨在探讨是否以及如何在当地环境中实施 WHO 指南，以告知未来指南实施的成功。方法 2018 年 3 月至 2018 年 12 月期间，对世卫组织指南制定者、总部工作人员以及区域和国家办事处工作人员进行了 17 次访谈。参与者是从各种世卫组织指南中特意抽取的，滚雪球抽样被用来确定区域和国家办事处的工作人员。使用扎根理论作为分析方法，通过三个编码阶段对去识别的转录本进行了分析。结果 世卫组织指南在世卫组织各级工作中发挥了多种作用。世卫组织官员和地方政府官员利用世卫组织指南影响卫生政策。我们将指南的用途分类为 (1) 直接改变政策，(2) 证明政策改变的正当性，(3) 让利益相关者参与，(4) 作为合法性的保证者，(5) 作为宣传工具，以及 (6) 与 WHO 的各种角色。与会者驳斥了将指南视为需要在不同情况下实施的技术建议列表的看法。我们发现存在，质量和信誉，而不是指南的内容，是不同地方环境下卫生政策变革举措的关键。结论 作为决策者合法性的保证者，WHO 指南可以更好地影响卫生政策和实践变化。了解指南的各种作用可以帮助 WHO 制定者打包指南以优化其有效实施。伦理 本项目经悉尼大学（项目编号：2017/723）和世卫组织（协议 ID：00001）的伦理批准进行。