Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

Baker, Richard; Camosso-Stefinovic, Janette; Gillies, Clare; Shaw, Elizabeth J; Cheater, Francine; Flottorp, Signe; Robertson, Noelle

doi:10.1002/14651858.cd005470.pub2

Cited by 1,003Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

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Baker, Richard, Camosso-Stefinovic, Janette, Gillies, Clare, Shaw, Elizabeth J, Cheater, Francine, Flottorp, Signe, Robertson, Noelle·2010·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd005470.pub2PMC PMC4164371

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Abstract

BACKGROUND: In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain. OBJECTIVES: To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes. SEARCH STRATEGY: For this update, in addition to the EPOC Register and pending files, we searched the following databases without language restrictions, from inception until August 2007: MEDLINE, EMBASE, CINAHL, BNI and HMIC. We searched the National Research Register to November 2007. We undertook further searches to October 2009 to identify potentially eligible published or ongoing trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) of interventions tailored to address prospectively identified barriers to change that reported objectively measured professional practice or healthcare outcomes in which at least one group received an intervention designed to address prospectively identified barriers to change. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed quality and extracted data. We undertook quantitative and qualitative analyses. The quantitative analyses had two elements.1. We carried out a meta-regression to compare interventions tailored to address identified barriers to change with either no interventions or an intervention(s) not tailored to the barriers.2. We carried out heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, concealment of allocation, rigour of barrier analysis, use of theory, complexity of interventions, and the reported presence of administrative constraints. MAIN RESULTS: We included 26 studies comparing an intervention tailored to address identified barriers to change to no intervention or an intervention(s) not tailored to the barriers. The effect sizes of these studies varied both across and within studies.Twelve studies provided enough data to be included in the quantitative analysis. A meta-regression model was fitted adjusting for baseline odds by fitting it as a covariate, to obtain the pooled odds ratio of 1.54 (95% CI, 1.16 to 2.01) from Bayesian analysis and 1.52 (95% CI, 1.27 to 1.82, P < 0.001) from classical analysis. The heterogeneity analyses found that no study attributes investigated were significantly associated with effectiveness of the interventions. AUTHORS' CONCLUSIONS: Interventions tailored to prospectively identified barriers are more likely to improve professional practice than no intervention or dissemination of guidelines. However, the methods used to identify barriers and tailor interventions to address them need further development. Research is required to determine the effectiveness of tailored interventions in comparison with other interventions.

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Competing priorities, lack of motivation, and low awareness of the intervention were shown to impede implementation.
“Competing priorities [42, 57, 59, 62, 63, 70, 82], lack of motivation [31, 39, 42, 57, 68, 81] and low awareness of the intervention [31, 35, 38, 39, 43, 44, 68, 75, 80, 81] were shown to impede implementation.”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [63]
The Results (Description of studies; page not specified) identify a perception that a clinical issue was not a priority, negative staff attitudes, and lack of time as barriers, supporting the competing-priorities point and relating to motivation. They do not identify lack of motivation specifically or low awareness of the intervention as barriers. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Several new studies of tailored intervention strategies have been published since the last revision of this review.
“Since the publication of the last revision of this review (Baker 2010), several new studies of tailored intervention strategies have been published.”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
Two review authors independently extracted the data from included studies.
“Two review authors independently extracted the data from included studies by using a revised version of the data extraction form used in the previous version of the review (Baker 2010).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
In this update, we identified an additional nine studies, seven of which had been published since the previous version of the review.
“In this update of our review of randomised trials of tailored implementation interventions, we identified an additional nine studies, seven of which had been published since the previous version of the review (Baker 2010).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
The previous version of the review included 26 trials.
“26 were included in the previous version (Baker 2010)”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010

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Research works printed but not linked: 5

Fretheim A Oxman AD Flottorp S Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change BMC Health Services Research 3 9 2004 4 1 23 15347426 PMC517506
Cochrane Effective Practice and Organisation of Care Group Data Collection Checklist EPOC resources for review authors 2002 http://www.epoc.cochrane.org/en/handsearchers.html Revised
Cochrane Effective Practice and Organisation of Care Group Updated 2007 Guide for Review Authors. 3 - Developing a protocol http://www.epoc.cochrane.org/en/handsearchers.html
Cochrane Effective Practice and Organisation of Care Group last accessed: 24 November 2009 EPOC resources for review authors http://www.epoc.cochrane.org/en/handsearchers.html
Légaré F Straus S Tetroe J Graham ID Assessing barriers and facilitators to knowledge use Knowledge Translation in Health Care 2009 Blackwell Publishing Ltd Oxford Chapter 3.4

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Clinical Practice Guidelines We Can Trust
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Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions
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Methods to Improve the Selection and Tailoring of Implementation Strategies
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Audit and feedback: effects on professional practice and health care outcomes
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Printed educational materials: effects on professional practice and healthcare outcomes
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Interventions for improving the adoption of shared decision making by healthcare professionals
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Tailored interventions to address determinants of practice
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Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews
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Gaps between knowing and doing: Understanding and assessing the barriers to optimal health care
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A guiding framework and approach for implementation research in substance use disorders treatment.
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Reducing the Global Burden of Cardiovascular Disease, Part 2
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Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families: A Multicenter Survey of Clinicians
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No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention
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The BARRIERS scale -- the barriers to research utilization scale: A systematic review
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Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review
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The Canadian Critical Care Nutrition Guidelines in 2013: An Update on Current Recommendations and Implementation Strategies
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The effects of care bundles on patient outcomes: a systematic review and meta-analysis
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Implementation strategies for health systems in low-income countries: an overview of systematic reviews
Tomás Pantoja, C., Opiyo, N., Lewin, S. A., Paulsen, E., Ciapponi, A., Wiysonge, C. S., Herrera, C. A., Gabriel Rada, G., Peñaloza, B., Dudley, L., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011086.pub2 · Cited by 258 · see citing works
Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews
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The effect of scientific evidence on conservation practitioners’ management decisions
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Trends in guideline implementation: a scoping systematic review
and the members of the Guidelines International Network Implementation Working Group, Gagliardi, A. R., & Alhabib, S. M. (2015) · Implementation Science · doi:10.1186/s13012-015-0247-8 · Cited by 228 · see citing works
CFIR simplified: Pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for evaluation of a patient‐centered care transformation within a learning health system
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Tracking implementation strategies: a description of a practical approach and early findings
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Developing and selecting interventions for translating knowledge to action
Wensing, M., Bosch, M., & Grol, R. P. T. M. (2009) · Canadian Medical Association Journal · doi:10.1503/cmaj.081233 · Cited by 203 · see citing works
Expert recommendations for implementing change (ERIC): protocol for a mixed methods study
Waltz, T. J., Powell, B. J., Chinman, M. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., Damschroder, L. J., & Kirchner, J. E. (2014) · Implementation Science · doi:10.1186/1748-5908-9-39 · Cited by 202 · see citing works
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
Lewin, S. A., Lavis, J. N., Oxman, A. D., Gabriel Bastías, S., Chopra, M., Ciapponi, A., Flottorp, S. A., Martí, S. G., Tomás Pantoja, C., Gabriel Rada, G., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61403-8 · Cited by 195 · see citing works
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Utilization and development of systematic reviews in management research: What do we know and where do we go from here?
Rojon, C., Okupe, A., & McDowall, A. (2021) · International Journal of Management Reviews · doi:10.1111/ijmr.12245 · Cited by 192 · see citing works
Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study
Varsi, C., Ekstedt, M., Gammon, D., & Ruland, C. M. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.5091 · Cited by 191 · see citing works
Strategies for Promoting Organizational and Practice Change by Advancing Implementation Research
Rubenstein, L. V., & Pugh, J. A. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00364.x · Cited by 189 · see citing works
Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012
Scott, A., Docking, S., Vicenzino, B., Alfredson, H., Zwerver, J., Lundgreen, K., Finlay, O. J. A., Pollock, N., Cook, J. L., Fearon, A., et al. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092329 · Cited by 186 · see citing works
Tailored Implementation for Chronic Diseases (TICD): a project protocol
Wensing, M., Oxman, A., Baker, R., Godycki-Cwirko, M., Flottorp, S., Szecsenyi, J., Grimshaw, J., & Eccles, M. (2011) · Implementation Science · doi:10.1186/1748-5908-6-103 · Cited by 184 · see citing works
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Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users
de Veer, A. J. E., Fleuren, M. A. H., Bekkema, N., & Francke, A. L. (2011) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-11-67 · Cited by 180 · see citing works
Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings
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Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods
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Factors influencing the development of evidence-based practice among nurses: a self-report survey
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Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes
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Research Utilization and Evidence-Based Practice in Occupational Therapy: A Scoping Study
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Trends in guideline implementation: an updated scoping review
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Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit?
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The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review
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Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review
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Tools developed and disseminated by guideline producers to promote the uptake of their guidelines
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Strategies for improving the quality of health care in maternal and child health in low‐ and middle‐income countries: an overview of systematic reviews
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Rater Training to Support High-Stakes Simulation-Based Assessments
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Oral health care in older people in long term care facilities: A systematic review of implementation strategies
Weening-Verbree, L. F., Waal, G. H., van Dusseldorp, L., van Achterberg, T., & Schoonhoven, L. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.12.004 · Cited by 155 · see citing works
Printed educational materials: effects on professional practice and healthcare outcomes
Giguere, A. M. C., Zomahoun, H. T. V., Carmichael, P., Uwizeye, C. B., Légaré, F., Grimshaw, J., Gagnon, M., Auguste, D. U., & Massougbodji, J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004398.pub4 · Cited by 155 · see citing works
Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat
Flottorp, S., Oxman, A. D., Håvelsrud, K., Treweek, S., & Herrin, J. (2002) · BMJ · doi:10.1136/bmj.325.7360.367 · Cited by 154 · see citing works
Self-citation
Contextual influences on health worker motivation in district hospitals in Kenya
Mbindyo, P., Gilson, L., Blaauw, D., & English, M. (2009) · Implementation Science · doi:10.1186/1748-5908-4-43 · Cited by 154 · see citing works
Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial
French, S. D., McKenzie, J. E., O’Connor, D. A., Grimshaw, J., Mortimer, D., Francis, J., Michie, S., Spike, N., Schattner, P. L., Kent, P. M., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065471 · Cited by 153 · see citing works
Leveraging human-centered design to implement modern psychological science: Return on an early investment.
Lyon, A. R., Brewer, S. K., & Areán, P. A. (2020) · American Psychologist · doi:10.1037/amp0000652 · Cited by 152 · see citing works
Why are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 152 · see citing works
Resource Effective Strategies to Prevent and Treat Cardiovascular Disease
Schwalm, J.-D., McKee, M., Huffman, M. D., & Yusuf, S. (2016) · Circulation · doi:10.1161/circulationaha.115.008721 · Cited by 152 · see citing works
Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
Bernhardsson, S., Johansson, K. M., Nilsén, P., Öberg, B. E., & Larsson, M. E. H. (2013) · Physical Therapy · doi:10.2522/ptj.20130147 · Cited by 151 · see citing works
Developing a checklist for guideline implementation planning: review and synthesis of guideline development and implementation advice
Gagliardi, A. R., Marshall, C., Huckson, S., James, R., & Moore, V. (2015) · Implementation Science · doi:10.1186/s13012-015-0205-5 · Cited by 150 · see citing works
Nurses’ wishes, knowledge, attitudes and perceived barriers on implementing research findings into practice among graduate nurses in Austria
Breimaier, H. E., Halfens, R. J. G., & Lohrmann, C. (2011) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2010.03491.x · Cited by 147 · see citing works
Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area
Ruzek, J. I., & Rosen, R. C. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.008 · Cited by 145 · see citing works
Knowledge translation and implementation research in nursing
Wallin, L. (2008) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2008.05.006 · Cited by 144 · see citing works
Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework
the Canada PRIme Plus Team, Bussières, A., Patey, A. M., Francis, J., Sales, A. E., & Grimshaw, J. (2012) · Implementation Science · doi:10.1186/1748-5908-7-82 · Cited by 143 · see citing works
Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene
Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2011) · Journal of Infection Prevention · doi:10.1177/1757177410384300 · Cited by 142 · see citing works
Self-citation
Interventions to improve professional adherence to guidelines for prevention of device-related infections
Flodgren, G., Conterno, L. D. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006559.pub2 · Cited by 141 · see citing works
Use of theory to plan or evaluate guideline implementation among physicians: a scoping review
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High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing
Paton, C., Barnes, T. R. E., Cavanagh, M.-R., Taylor, D. M., & Lelliott, P. T. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.042895 · Cited by 138 · see citing works
Barriers to accessing methamphetamine treatment: A systematic review and meta-analysis
Cumming, C., Troeung, L., Young, J. T., Kelty, E. A., & Preen, D. B. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.10.001 · Cited by 132 · see citing works
Strategies to Improve Adverse Drug Reaction Reporting: A Critical and Systematic Review
González-González, C., Lopez-Gonzalez, E., Herdeiro, M. T., & Figueiras, A. (2013) · Drug Safety · doi:10.1007/s40264-013-0058-2 · Cited by 131 · see citing works
Implementation of safety checklists in surgery: a realist synthesis of evidence
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Tailored interventions to address determinants of practice
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Authors: Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., & Robertson, N.
Affiliations: University of Leicester (GB)
National Institute for Health and Care Excellence (GB)
Glasgow Caledonian University (GB)
Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
ORCID: Baker, Richard
Gillies, Clare
Shaw, Elizabeth J
Cheater, Francine
Flottorp, Signe
Robertson, Noelle
Venue: Cochrane Database of Systematic Reviews
Publisher: John Wiley & Sons, Ltd
Published: 2010-03-17
Issue: 3
Pages: CD005470-CD005470
ISSN: 1361-6137 (ISSN-L)
DOI: 10.1002/14651858.cd005470.pub2
PMC: PMC4164371
OpenAlex: W2100564574
Cited by: 1,003
References: 156
Citations by year: 2026: 15 · 2025: 19 · 2024: 39 · 2023: 34 · 2022: 43 · 2021: 61 · 2020: 55 · 2019: 44 · 2018: 43 · 2017: 59 · 2016: 68 · 2015: 108 · 2014: 97 · 2013: 87 · 2012: 67
Type: reference entry
Language: en
Update notices: new_version (2015-04-29)
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Leicester Research Archive (University of Leicester) (submittedVersion)
ResearchOnline (Glasgow Caledonian University) (submittedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: intervention, barriers to change, professional practice change, health care outcomes, behaviour change interventions, intervention tailoring, guideline dissemination, risk of bias, allocation concealment, theory-based intervention, administrative constraints, smoking cessation, physical activity promotion, diabetes self-management, chronic disease management
MeSH terms: Humans, Outcome and Process Assessment, Health Care, Professional Practice, Randomized Controlled Trials as Topic

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Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

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