Original Article
Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review

https://doi.org/10.1016/j.jclinepi.2014.12.013Get rights and content
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Abstract

Objectives

To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake.

Study Design and Setting

We conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies. Analysis involved the development of a codebook of definitions, validation of data, and development of hierarchical narratives to explain guideline implementability.

Results

We found that guideline implementability is associated with two broad goals in guideline development: (1) creation of guideline content, which involves addressing the domains of stakeholder involvement in CPGs, evidence synthesis, considered judgment (eg, clinical applicability), and implementation feasibility and (2) the effective communication of this content, which involves domains related to fine-tuning the CPG's message (using simple, clear, and persuasive language) and format.

Conclusion

Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.

Keywords

Guideline implementability
Guideline adherence
Clinical practice guideline
Systematic review
Realist review

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Funding: This study was funded by Knowledge Translation Canada through a Canadian Institutes of Health Research (CIHR)/Canadian Foundation for Innovation grants, and a CIHR AGREE-A3 grant.

Conflict of interest: None.