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

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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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Background
The ERCP Quality Network
Cotton, P., Romagnuolo, J., Faigel, D., Aliperti, G., & Deal, S. (2013) · American Journal of Medical Quality · doi:10.1177/1062860612456235 · Cited by 29
Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals.
Eskicioglu, C., Gagliardi, A., Fenech, D., Forbes, S., McKenzie, M., Mcleod, R., & Nathens, A. (2012) · Canadian journal of surgery. Journal canadien de chirurgie · doi:10.1503/cjs.036810 · Cited by 29
Use of a time series design to test effectiveness of a theory‐based intervention targeting adherence of health professionals to a clinical guideline
Hanbury, A., WALLACE, L. M., & Clark, M. (2008) · British Journal of Health Psychology · doi:10.1348/135910708x369558 · Cited by 30
Self-reports and Observer Reports as Data Generation Methods: An Assessment of Issues of Both Methods
Abernethy, M. (2015) · doi:10.13189/ujp.2015.030104 · Cited by 29
The Role of the Researcher in Making Serious Games for Health
Kato, P. M. (2015) · IGI Global eBooks · doi:10.4018/978-1-4666-6433-3.ch072 · Cited by 29
What factors increase Dutch child health care professionals’ adherence to a national guideline on preventing child abuse and neglect?
Konijnendijk, A. A. J., Boere-Boonekamp, M. M., Fleuren, M. A. H., Haasnoot, M. E., & Need, A. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.11.006 · Cited by 28
The Twitter Social Mobility Index: Measuring Social Distancing Practices from Geolocated Tweets
Xu, P., Dredze, M., & Broniatowski, D. A. (2020) · arXiv.org · doi:10.48550/arxiv.2004.02397 · Cited by 28
“Additionally, polling around public health issues suffers from response bias, as individuals may overstate their compliance with established public health recommendations (Adams et al., 1999).”
Background
An assessment of the relationship of physical activity, obesity, and chronic diseases/conditions between active/obese and sedentary/ normal weight American women in a national sample
Pharr, J. R., Coughenour, C., & Bungum, T. J. (2018) · Public Health · doi:10.1016/j.puhe.2017.12.013 · Cited by 30
Reasons for End-of-Life Hospital Admissions: Results of a Survey Among Family Physicians.
Reyniers, T., Deliens, L., Pasman, H., Stichele, R. V., Sijnave, B., Cohen, J., & Houttekier, D. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.05.014 · Cited by 28
Program Capacity to Eliminate Outcome Disparities in Addiction Health Services
Guerrero, E., Aarons, G. A., Grella, C., Garner, B. R., Cook, B., & Vega, W. (2016) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-014-0617-6 · Cited by 28
“To reduce the effect of upward reporting bias associated with managers’ reports on program context (Adams et al. 1999; Lee and Cameron 2009), we used a systematic approach to”
BackgroundMethod
The delivery of preventive care to clients of community health services
McElwaine, K., Freund, M., Campbell, E. M., Knight, J., Bowman, J., Doherty, E. L., Wye, P. M., Wolfenden, L., Lecathelinais, C., McLachlan, S., et al. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-167 · Cited by 29
“Finally, past studies have most commonly relied on clinician self-report, a measurement approach likely to result in an overestimate of care delivery [44].”
Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire
Domenech, J., Segura-Ortí, E., Lisón, J., EspejoTort, B., & Sánchez-Zuriaga, D. (2013) · European spine journal · doi:10.1007/s00586-012-2604-5 · Cited by 28
“The responses to clinical cases may be biased towards treatment guidelines recommendations as a result of desirability phenomena [34] and it may”
Background
Cluster Randomized Trials of Professional and Organizational Behavior Change Interventions in Health Care Settings
Grimshaw, J., Eccles, M., Campbell, M., & Elbourne, D. (2005) · The Annals of the American Academy of Political and Social Science · doi:10.1177/0002716205274576 · Cited by 28
Provision of information and advice in cardiovascular care: clinical performance of general practitioners.
Frijling, B., Lobo, C. M., Hulscher, M., van Drenth, B. B., Braspenning, J., Prins, A., van der Wouden, J. C., & Grol, R. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(02)00013-7 · Cited by 28
Calcium Hydroxylapatite (CaHA) and Aesthetic Outcomes: A Systematic Review of Controlled Clinical Trials
Amiri, M., Meçani, R., Llanaj, E., Niehot, C., Phillips, T. L., Goldie, K., Kolb, J., Muka, T., & Daughtry, H. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061686 · Cited by 27
“…the extent of differences, changes, and comparisons within or between intervention and control groups The evaluation methods employed for the majority of the study outcomes were subjective, making them susceptible to bias, which could impact the reliability and consistency of the findings [53].”
Method
Closing the evidence-practice gaps in aphasia management: are we there yet? Where has a decade of implementation research taken us? A review and guide for clinicians
Shrubsole, K., Worrall, L. E., & Power, E. (2018) · Aphasiology · doi:10.1080/02687038.2018.1510112 · Cited by 26
Blood donor deferral for men who have sex with men: still room to move
Haire, B., Whitford, K., & Kaldor, J. (2018) · Transfusion · doi:10.1111/trf.14445 · Cited by 27
Monitoring patient care through health facility exit interviews: an assessment of the Hawthorne effect in a trial of adherence to malaria treatment guidelines in Tanzania
Leurent, B., Reyburn, H., Muro, F. J., Mbakilwa, H., & Schellenberg, D. M. (2016) · BMC Infectious Diseases · doi:10.1186/s12879-016-1362-0 · Cited by 19
“One can review routine documentation of the consultation, although the reliability of self-reported practices is uncertain [12].”
Background
Effectiveness and safety of artemether–lumefantrine versus artesunate–amodiaquine for unsupervised treatment of uncomplicated falciparum malaria in patients of all age groups in Nanoro, Burkina Faso: a randomized open label trial
Sondo, P., Derra, K., Diallo-Nakanabo, S., Tarnagda, Z., Zampa, O., Kazienga, A., Valéa, I., Sorgho, H., Owusu-Dabo, E., Ouédraogo, J., et al. (2015) · Malaria Journal · doi:10.1186/s12936-015-0843-8 · Cited by 27
“This constituted one of the limitations of our study because some studies have shown a difference in adherence rate obtained by the use of different methods and the assessment based on patients self-reporting seems not to be the most appropriate [15, 16].”
Result
Relationship of Combat Experiences and Alcohol Misuse Among U.S. Special Operations Soldiers
Skipper, L. D., Forsten, R. D., Kim, E. H., Wilk, J. E., & Hoge, C. W. (2014) · Military Medicine · doi:10.7205/milmed-d-13-00400 · Cited by 31
“193(51)* 76 (20) 93 (25) 136 (36) 211 (56) 149 (39)”
Methodology and bias in assessing compliance with a surgical safety checklist.
Poon, S. J., Zuckerman, S., Mainthia, R., Hagan, S. L., Lockney, D. T., Zotov, A., Holt, G., Bennett, M. L., Anders, S., & France, D. (2013) · Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(13)39011-4 · Cited by 27
Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings
McGovern, M. P., Urada, D. I., Lambert-Harris, C. A., Sullivan, S. T., & Mazade, N. A. (2012) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2012.08.013 · Cited by 29
Does optometrists’ self‐reported practice in glaucoma detection predict actual practice as determined by standardised patients?
Theodossiades, J., Myint, J., Murdoch, I. E., Edgar, D., & Lawrenson, J. (2012) · Ophthalmic & physiological optics · doi:10.1111/j.1475-1313.2012.00898.x · Cited by 27
“Significantly, substantial overestimation has been observed when investigating adherence to best practice guidelines.(7,8) Several studies have used questionnaires to gain insights into case-finding strategies used by community optometrists.”
Postoperative Schmerztherapie nach ambulanten Operationen
Lux, E., Stamer, U., Meissner, W., & Wiebalck, A. (2008) · Der Schmerz · doi:10.1007/s00482-011-1022-7 · Cited by 27
Screening for type 2 diabetes mellitus in children and adolescents: attitudes, barriers, and practices among pediatric clinicians.
Rhodes, E., Finkelstein, J., Marshall, R. E., Allen, C., Gillman, M., & Ludwig, D. S. (2006) · Ambulatory Pediatrics · doi:10.1016/j.ambp.2005.10.005 · Cited by 27
Primary Care Physician Referral Patterns to Diabetes Education Programs in Southern Ontario, Canada
Gucciardi, E., Chan, V. W.-S., Fortugno, M., Khan, S., Horodezny, S., & Swartzack, S. J. (2011) · Canadian Journal of Diabetes · doi:10.1016/s1499-2671(11)53009-6 · Cited by 29

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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