Barriers and facilitators to implementing pulmonary rehabilitation guidelines in China: a qualitative study using implementation science frameworks.

OBJECTIVE

To understand barriers and facilitators to the implementation of pulmonary rehabilitation guidelines in pulmonary and critical care medicine (PCCM) from an interdisciplinary perspective and to determine potential contextual implementation strategies.

DESIGN

A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF).

SETTING

Four departments of pulmonary and critical care medicine in China.

PARTICIPANTS

Forty-two healthcare professionals (12 physicians, 22 nurses, 4 rehabilitation therapists, 2 respiratory therapists, and 2 physiotherapists).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We conducted semi-structured interviews with healthcare professionals. Transcripts of the semi-structured interviews were analysed using content analysis. Data were coded using a deductive approach. Identified factors influencing non-adherence and utilization of guidelines were then mapped to corresponding intervention strategies from the CFIR-Expert Recommendations for Implementing Change compilation (ERIC) database.

RESULTS

Our analysis revealed barriers and facilitators across three themes: opportunity and support, staff characteristics and motivating factors. Key barriers to guideline implementation encompassed environmental hindrances, guideline complexity and time restriction, poor interdisciplinary communication, lack of awareness, knowledge or skills, capability concerns, and vague professional roles. Potential facilitators included social support and peer influence, MOH policies, robust evidence base and contextual adaptability, planning, monitoring, feedback, autonomous motivation, sense of optimism, and positive outcome expectations of guideline adoption. Environmental restructuring, educational meeting and ongoing training, clinician implementation team meetings and electronic order sets/digital proforma may be needed to facilitate guideline implementation.

CONCLUSIONS

CFIR and TDF provided valuable frameworks for evaluating both contextual-level and individual-level facilitators and barriers to implementing pulmonary rehabilitation guidelines and understanding what adaptations may be needed to improve compliance. These would be essential to inform future interventions in the PCCM and contribute to optimize pulmonary rehabilitation management.