Wu Shiyin, Wang Lingjie, Li Changle, Liu Wenbin
Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, Fuzhou, Fujian, China.
Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, Fuzhou, Fujian, China.
Int J Nurs Stud. 2025 Jul;167:105073. doi: 10.1016/j.ijnurstu.2025.105073. Epub 2025 Mar 27.
Poor adherence to clinical practice guidelines among healthcare workers could have negative impacts on the effectiveness of care, patient health outcomes, and healthcare costs. Social norm feedback can be an essential means of achieving the intended intervention goals by providing information to the intervention target regarding the values, attitudes, or behaviors of the reference group or individual. However, there is a lack of consensus on the effectiveness of social norm feedback in improving adherence to clinical practice guidelines among healthcare workers. Therefore, this systematic review aimed to assess the effects of social norm feedback on adherence to clinical practice guidelines among healthcare workers and its characteristics in behavior change techniques.
Searches of PubMed, Web of Science, Cochrane Central Register of Controlled Trials (via CENTRAL), EMBASE (via OVID), MEDLINE (via OVID), and Scopus were preformed to identify peer-reviewed studies published until February 29, 2024. Randomized controlled trials reporting social norm feedback interventions (social comparison, information about others' approval, credible source, social reward, and social incentive) to support compliance with clinical practice guidelines were included. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias 2.0 tool and the certainty of evidence was rated using the GRADE method. Pooled data were analyzed in Stata 17.0 using a random effects model meta-analysis.
A total of 31 articles (30 studies) were identified. Fifteen behavior change techniques were tested in the included studies. The three most commonly used behavior change techniques in clinical practice guidelines were social comparison, feedback on the outcome of behavior, and social support. A meta-analysis showed that social norm feedback appeared to be an effective strategy to improve adherence to clinical practice guidelines among healthcare workers, with a rate difference (RD) of 0.04 (95 % confidence interval [CI] 0.02-0.06). Credible source (RD 0.12, 95 % CI 0.06-0.19) and multiple social norms behavioral change techniques (RD 0.05, 95 % CI 0.04-0.06) seemed effective when combined with other behavioral change techniques, compared to the control condition. The certainty of evidence across the outcomes ranged from very low to high based on the GRADE approach.
Social norm feedback appears to be an effective method for improving adherence to clinical practice guidelines among healthcare workers. This review provides a broad understanding of how social norm feedback can be applied to improve adherence of healthcare workers to clinical practice guidelines, ultimately improving patient health and quality of care.
PROSPERO CRD42023411582.
医护人员对临床实践指南的依从性差可能会对护理效果、患者健康结局和医疗成本产生负面影响。社会规范反馈可以通过向干预对象提供有关参照群体或个人的价值观、态度或行为的信息，成为实现预期干预目标的重要手段。然而，对于社会规范反馈在提高医护人员对临床实践指南依从性方面的有效性，目前尚无共识。因此，本系统评价旨在评估社会规范反馈对医护人员遵循临床实践指南的影响及其在行为改变技术方面的特征。
检索了PubMed、科学网、Cochrane对照试验中心注册库（通过CENTRAL）、EMBASE（通过OVID）、MEDLINE（通过OVID）和Scopus，以识别截至2024年2月29日发表的同行评审研究。纳入报告社会规范反馈干预措施（社会比较、他人认可信息、可靠来源、社会奖励和社会激励）以支持遵循临床实践指南的随机对照试验。使用Cochrane偏倚风险2.0工具评估单个研究的偏倚风险，并使用GRADE方法对证据的确定性进行评级。在Stata 17.0中使用随机效应模型荟萃分析对汇总数据进行分析。
共识别出31篇文章（30项研究）。纳入的研究中测试了15种行为改变技术。临床实践指南中最常用的三种行为改变技术是社会比较、行为结果反馈和社会支持。荟萃分析表明，社会规范反馈似乎是提高医护人员对临床实践指南依从性的有效策略，率差（RD）为0.04（95%置信区间[CI]0.02 - 0.06）。与对照条件相比，可靠来源（RD 0.12，95% CI 0.06 - 0.19）和多种社会规范行为改变技术（RD 0.05，95% CI 0.04 - 0.06）与其他行为改变技术结合时似乎有效。根据GRADE方法，各结局的证据确定性从极低到高不等。
社会规范反馈似乎是提高医护人员对临床实践指南依从性的有效方法。本综述提供了对社会规范反馈如何应用于提高医护人员对临床实践指南的依从性的广泛理解，最终改善患者健康和护理质量。
PROSPERO CRD42023411582。
