Evidence of self-report bias in assessing adherence to guidelines

Adams, A.; Soumerai, S.; Lomas, J; Ross-Degnan, D

doi:10.1093/intqhc/11.3.187

Cited by 679Clinical practice guidelines implementationSurvey Methodology and NonresponseHealth Sciences Research and Education

Evidence of self-report bias in assessing adherence to guidelines

Adams, A., Soumerai, S., Lomas, J, Ross-Degnan, D·1999·International Journal for Quality in Health Care

DOI 10.1093/intqhc/11.3.187

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Abstract

Objective To assess trends in the use of self-report measures in research on adherence to practice guidelines since 1980, and to determine the impact of response bias on the validity of self-reports as measures of quality of care. Methods We conducted a MEDLINE search using defined search terms for the period 1980 to 1996. Included studies evaluated the adherence of clinicians to practice guidelines, official policies, or other evidence-based recommendations. Among studies containing both self-report (e.g. interviews) and objective measures of adherence (e.g. medical records), we compared self-reported and objective adherence rates (measured as per cent adherence). Evidence of response bias was defined as self-reported adherence significantly exceeding the objective measure at the 5% level. Results We identified 326 studies of guideline adherence. The use of self-report measures of adherence increased from 18% of studies in 1980 to 41% of studies in 1985. Of the 10 studies that used both self-report and objective measures, eight supported the existence of response bias in all self-reported measures. In 87% of 37 comparisons, self-reported adherence rates exceeded the objective rates, resulting in a median over-estimation of adherence of 27% (absolute difference). Conclusions Although self-reports may provide information regarding clinicians' knowledge of guideline recommendations, they are subject to bias and should not be used as the sole measure of guideline adherence.

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Self-reported adherence is simple and cost-effective but prone to recall and social desirability bias.
“Self-reported adherence is simple and cost-effective but prone to recall and social desirability bias.130,131,133,134”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [133]

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Authors: Adams, A., Soumerai, S., Lomas, J., & Ross-Degnan, D.
Affiliations: Harvard University (US)
Canadian Foundation for Healthcare Improvement (CA)
ORCID: Adams, A.
Soumerai, S.
Venue: International Journal for Quality in Health Care
Publisher: Oxford University Press (OUP)
Published: 1999-06-01
Volume: 11
Issue: 3
Pages: 187-192
ISSN: 1353-4505 (ISSN-L)
1464-3677
DOI: 10.1093/intqhc/11.3.187
OpenAlex: W2074448530
Cited by: 679
References: 0
Citations by year: 2026: 28 · 2025: 19 · 2024: 28 · 2023: 23 · 2022: 17 · 2021: 27 · 2020: 28 · 2019: 36 · 2018: 36 · 2017: 36 · 2016: 37 · 2015: 36 · 2014: 44 · 2013: 39 · 2012: 36
FWCI: 11.86
Type: journal article
Language: en
Open access: closed
Locations: International Journal for Quality in Health Care (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (5R18HS07357)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: self-report bias, response bias, guideline adherence, clinical guidelines, quality of care, evidence-based medicine
MeSH terms: Humans, Interviews as Topic, Psychometrics, Surveys and Questionnaires, Reproducibility of Results, Bias, Practice Guidelines as Topic, Guideline Adherence

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Evidence of self-report bias in assessing adherence to guidelines

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