School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
Implement Sci. 2022 Jul 23;17(1):50. doi: 10.1186/s13012-022-01223-6.
Guidelines aim to support evidence-informed practice but are inconsistently used without implementation strategies. Our prior scoping review revealed that guideline implementation interventions were not selected and tailored based on processes known to enhance guideline uptake and impact. The purpose of this study was to update the prior scoping review.
We searched MEDLINE, EMBASE, AMED, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews for studies published from 2014 to January 2021 that evaluated guideline implementation interventions. We screened studies in triplicate and extracted data in duplicate. We reported study and intervention characteristics and studies that achieved impact with summary statistics.
We included 118 studies that implemented guidelines on 16 clinical topics. With regard to implementation planning, 21% of studies referred to theories or frameworks, 50% pre-identified implementation barriers, and 36% engaged stakeholders in selecting or tailoring interventions. Studies that employed frameworks (n=25) most often used the theoretical domains framework (28%) or social cognitive theory (28%). Those that pre-identified barriers (n=59) most often consulted literature (60%). Those that engaged stakeholders (n=42) most often consulted healthcare professionals (79%). Common interventions included educating professionals about guidelines (44%) and information systems/technology (41%). Most studies employed multi-faceted interventions (75%). A total of 97 (82%) studies achieved impact (improvements in one or more reported outcomes) including 10 (40% of 25) studies that employed frameworks, 28 (47.45% of 59) studies that pre-identified barriers, 22 (52.38% of 42) studies that engaged stakeholders, and 21 (70% of 30) studies that employed single interventions.
Compared to our prior review, this review found that more studies used processes to select and tailor interventions, and a wider array of types of interventions across the Mazza taxonomy. Given that most studies achieved impact, this might reinforce the need for implementation planning. However, even studies that did not plan implementation achieved impact. Similarly, even single interventions achieved impact. Thus, a future systematic review based on this data is warranted to establish if the use of frameworks, barrier identification, stakeholder engagement, and multi-faceted interventions are associated with impact.
The protocol was registered with Open Science Framework ( https://osf.io/4nxpr ) and published in JBI Evidence Synthesis.
指南旨在支持循证实践，但如果没有实施策略，指南的使用往往不一致。我们之前的范围综述显示，指南实施干预措施的选择和调整并未基于已知可增强指南采用和影响的过程。本研究的目的是更新之前的范围综述。
我们在 MEDLINE、EMBASE、AMED、CINAHL、Scopus 和 Cochrane 系统评价数据库中搜索了 2014 年至 2021 年 1 月期间发表的评估指南实施干预措施的研究。我们进行了三次重复筛选并进行了两次数据提取。我们报告了研究和干预措施的特征以及具有汇总统计数据的实现影响的研究。
我们纳入了 118 项研究，这些研究针对 16 个临床主题实施了指南。在实施计划方面，21%的研究提到了理论或框架，50%的研究预先确定了实施障碍，36%的研究让利益相关者参与选择或调整干预措施。使用框架的研究（n=25）最常使用理论领域框架（28%）或社会认知理论（28%）。那些预先确定障碍的研究（n=59）最常参考文献（60%）。那些让利益相关者参与的研究（n=42）最常咨询医疗保健专业人员（79%）。常见的干预措施包括向专业人员提供有关指南的教育（44%）和信息系统/技术（41%）。大多数研究采用了多方面的干预措施（75%）。共有 97（82%）项研究实现了影响（一个或多个报告结果的改善），包括 10（25 项研究的 40%）采用框架的研究、28（59 项研究的 47.45%）预先确定障碍的研究、22（42 项研究的 52.38%）让利益相关者参与的研究和 21（30 项研究的 70%）采用单一干预措施的研究。
与我们之前的综述相比，本综述发现，更多的研究使用了选择和调整干预措施的过程，并且在 Mazza 分类法中使用了更广泛的干预措施类型。鉴于大多数研究都实现了影响，这可能强化了实施计划的必要性。然而，即使没有进行实施计划的研究也实现了影响。同样，即使是单一的干预措施也实现了影响。因此，基于这些数据进行的未来系统综述是有必要的，以确定使用框架、确定障碍、利益相关者参与和多方面干预措施是否与影响相关。
该方案在开放科学框架（https://osf.io/4nxpr）上进行了注册，并在 JBI 证据综合中发表。
