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Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes
Open accessAbstract
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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In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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
In the citing paper
“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 the citing paper
“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
In the citing paper
“26 were included in the previous version (Baker 2010)”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
In the citing paper
“The only reviews that have directly investigated the effects of tailored interventions are the previous versions of this review (Baker 2010; Shaw 2005).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Shaw 2005
In the citing paper
“The only reviews that have directly investigated the effects of tailored interventions are the previous versions of this review (Baker 2010; Shaw 2005).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
In the citing paper
“In the previous review (Baker 2010), we included a Bayesian analysis as well as a classical analysis, but since these approaches produced similar results, we used only the classical analysis in this review.”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Baker 2010
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Metadata
- 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)
- 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)
- 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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