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Developing an instrument for evaluating implementation of clinical practice guidelines: a test-retest study
Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV). Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV). Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV). Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
2008 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, no xxArticle in journal (Refereed)
Abstract [en]

Rationale and aims: This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. Method: A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Service (PARIHS)-model, influence the success of implementation. Thirty-nine professionals at one of the hospitals included in the survey completed the questionnaire on two occations within a mean time of 5.5 weeks. The test-retest reliability was analyzed by means of Cohen's Kapps and percentage concordance. Results: Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values 13 items show moderate and two fair agreement. Conclusions: The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd. , 2008. no xx
Keywords [en]
clinical practice guidelines, evaluating, implementation, test-retest
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-14859DOI: 10.1111/j.1365-2753.2007.00916.xISI: 000260544400034PubMedID: 18331325Scopus ID: 2-s2.0-55349117824Local ID: 6123OAI: oai:DiVA.org:mau-14859DiVA, id: diva2:1418380
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
In thesis
1. In search of evidence-based practices. Exploring factors influencing evidence-based practice and implementation of clinical practice guidelines
Open this publication in new window or tab >>In search of evidence-based practices. Exploring factors influencing evidence-based practice and implementation of clinical practice guidelines
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Within the evidence-based movement means are developed to support the practitioner in becoming a research consumer with knowledge and skills to create an evidence-based practice (EBP). But little is actually known about whether, and how, this evidence-based accumulation of knowledge is used by practitioners and in what way any actual use leads to improved outcomes. Clinical practice guidelines (CPGs) are described to provide means to keep up with scientific development and may serve as an interface between science and practice. Implementation of evidence and guidelines in daily care are very complex and knowledge about the best way to implement evidence to facilitate best practices is still limited. The overall aim of this thesis was to explore factors that influence an evidence-based clinical practice, and more specifically, to investigate outcomes of an evidence-based practice, the dissemination and awareness of evidence-based literature, and to describe factors of importance when implementing CPGs. A systematic review was conducted to identify outcomes, and different experimental designs have been used for the purpose of describing awareness and dissemination of evidence-based literature as well as experience of the implementation of CPGs. Furthermore, a test-retest was conducted to test the reliability of items constructed from factors drawn from The Promoting Action on Research Implementation in Health Services (PARIHS) framework.The findings of the systematic review showed that it is difficult to prove effects of an EBP and the studies that managed this had implemented evidence-based CPGs. Although improvements in outcomes were reported for patients, personnel and the organisation, the synthesis showed a weak scientific foundation for the overall result since the studies included were heterogeneous in their designs. In a questionnaire study, in the area of psychiatric nursing with a pre-post design in relation to published evidence-based nursing reports, some differences were detected over time. But still 39.5 % of the sample reported no access to evidence-based literature one year after the publication of the two evidence-based nursing reports, and few of the respondents who had access to evidence-based literature reported any use of it. In the test-retest items of factors such as clinical experience, patients experience, leadership, context, culture, evaluation and facilitation was included. The findings of the test-retest showed that the reliability varied from good to fair agreement regarding the Kappa values, with a predominance of moderate agreement. The interview study, with an interpretive qualitative design, revealed several factors that appeared to be of importance for the implementation CPGs. The factors seemed to form a base consisting of circumstances, conditions and requirements. These have a relation to components that constitute a process, thus illustrating that implementing CPGs are continuous processes of creating reliable and tenable routines which involve all staffs member and are expected to lead to better and safer care of patients and increase knowledge and confidence among the staff.In conclusion, it is complicated, but not impossible, to demonstrate the outcomes of an EBP. To implement evidence-based CPGs is one way to make an evidence-based care visible. But more research is needed to strengthen the scientific foundation and to establish whether the tendency towards improved outcomes reported can be further supported. To implement CPGs is described as processes of bringing about a certain level of best practice that benefits patients as well as the staff. There are several factors influencing the process in relation to both positive and negative aspects and depending on which aspects will rise in the foreground the processes are visible or concealed, move forward or stagnate, promote or impede a successful implementation.

Place, publisher, year, edition, pages
Malmö University, 2008. p. 94
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 4
Keywords
Evidence-Based Practice, Clinical Practice Guidelines, Implementation, Healthcare professionals, Nurse managers, Systematic Review, Questionnaire, Test-retest, Interview, Content Analysis
National Category
Health Sciences
Identifiers
urn:nbn:se:mau:diva-7318 (URN)6006 (Local ID)978-91-7104-216-3 (ISBN)6006 (Archive number)6006 (OAI)
Note

Note: The papers are not included in the fulltext online.

Paper III  in dissertation as accepted manuscript.

Paper IV in dissertation as manuscript with title "Experiences of implementation of clinical practice guidelines – interviews with nurse managers within hospital care".

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-05Bibliographically approved

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Bahtsevani, ChristelWillman, AniaÖstman, Margareta

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