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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Result
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Background
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Understanding adherence to assistive devices among older adults: a conceptual review
Tuazon, J. R., Jahan, A. M., & Jutai, J. W. (2018) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2018.1493753 · Cited by 19
Appropriateness and avoidability of terminal hospital admissions: Results of a survey among family physicians
Reyniers, T., Deliens, L., Pasman, H., Stichele, R. V., Sijnave, B., Houttekier, D., & Cohen, J. (2017) · Palliative Medicine · doi:10.1177/0269216316659211 · Cited by 17
Effectiveness of an Intervention to Enhance Occupational Physicians’ Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial
van Beurden, K. M., Brouwers, E. P. M., Joosen, M. C. W., de Boer, M. R., van Weeghel, J., Terluin, B., & van der Klink, J. J. L. (2016) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-016-9682-x · Cited by 27
“A previous study has shown that self-reported guideline adherence is not an accurate measure of guideline adherence [27], and therefore OPs may have overestimated their own behavior.”
Predictors of Non-adherence to Anti-Tuberculosis Medication in Tuberculosis Patients in Thailand
Peltzer, K., & Pengpid, S. (2015) · doi:10.1080/09709274.2015.11906927 · Cited by 17
“Since self-reported adherence was used in this study, the rate of reported non-adherence was likely to be an underestimation (Adams et al. 1999).”
Method
Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization
Stevans, J., Bise, C., McGee, J., Miller, D. L., Rockar, P., & Delitto, A. (2015) · Physical Therapy · doi:10.2522/ptj.20130541 · Cited by 17
Measuring Briefing and Checklist Compliance in Surgery
Johnston, F., Tergas, A., Bennett, J. L., Valero, V., Morrissey, C., Fader, A., Hobson, D., Weaver, S., Rosen, M., & Wick, E. (2014) · American Journal of Medical Quality · doi:10.1177/1062860613509402 · Cited by 17
“Both these methods carry inherent risk of bias, namely, self-serving bias (from individual involvement) and observer bias (from lack of familiarity with perioperative practices), respectively.(20,21) One quantitative approach that may counteract the risk of bias is the use of covert observers who are content experts.”
Background
Direct observation of weight counseling in primary care: alignment with clinical guidelines
Antognoli, E., Smith, K. J., Mason, M. J., Milliner, B., Davis, E., Harris-Haywood, S., Seeholzer, E., & Flocke, S. (2014) · Clinical Obesity · doi:10.1111/cob.12050 · Cited by 17
“Furthermore, most studies rely on patient or physician self-report through surveys or focus groups (5,11,13,14,22,23), which are methods prone to recall bias (24).”
Background
The Effects of Teacher Fidelity of Implementation of Pathways to Health on Student Outcomes
Little, M. A., Riggs, N. R., Shin, H.-S., Tate, E. B., & Pentz, M. A. (2013) · Evaluation & the Health Professions · doi:10.1177/0163278713489879 · Cited by 27
Modest Impact of a Brief Curricular Intervention on Poor Documentation of Sexual History in University-Based Resident Internal Medicine Clinics
Loeb, D. F., Aagaard, E., Cali, S. R., & Lee, R. S. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01883.x · Cited by 15
A multidisciplinary guideline for the acute phase of stroke: barriers perceived by Dutch neurologists.
van der Weijden, T., Hooi, J. D., Grol, R., & Limburg, M. (2004) · Journal of Evaluation In Clinical Practice · doi:10.1111/j.1365-2753.2003.00460.x · Cited by 17
Protocol implementation in hospital infection control practice: an Italian experience of preoperative antibiotic prophylaxis.
Brusaferro, S., Rinaldi, O., Pea, F., Faruzzo, A., & Barbone, F. (2001) · Journal of Hospital Infection · doi:10.1053/jhin.2001.0946 · Cited by 17
EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center
Tucker, S., McNett, M., O'Leary, C., Rosselet, R., Mu, J., Thomas, B. K., Gallagher‐Ford, L., & Melnyk, B. M. (2022) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12600 · Cited by 23
Recommendation and protocol compliance: “Yes, I do” may not be true; the complexity of measuring provider adherence
Labeau, S. (2020) · Intensive & Critical Care Nursing · doi:10.1016/j.iccn.2020.102890 · Cited by 16
“However, these methods generate subjective data and have long been recognised as being prone to result in overestimated adherence rates (Adams et al., 1999).”
Background
Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: a European survey
Díez, C. C., Khalil, F., Schwender, H., Dalinghaus, M., Jovanović, I., Makowski, N., Male, C., Bajčetić, M., van der Meulen, M. H., de Wildt, S. N., et al. (2019) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2018-000365 · Cited by 16
“limitations Our results are constrained by the reliance on self-reported clinicians’ practice.(39) We were not able to enrol a statistically representative sample and responses of an individual physician cannot be assumed to be consistent with practice of others from the same institution.”
Result
Exploring the Weight and Health Status of Adults with Down Syndrome
Havercamp, S. M., Tassé, M. J., Navas, P., Benson, B. A., Allain, D. C., & Manickam, K. (2017) · Journal of Education and Training Studies · doi:10.11114/jets.v5i6.2343 · Cited by 14
Improving Coordination of Addiction Health Services Organizations with Mental Health and Public Health Services
Guerrero, E., Andrews, C., Harris, L. M., Padwa, H., Kong, Y.-F., & Fenwick, K. M. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.08.002 · Cited by 16
Better Adherence to Treatment Recommendations in Heart Failure Predicts Improved Cognitive Function at a One Year Follow Up
Alosco, M., Spitznagel, M., Cohen, R., Sweet, L., Josephson, R., Hughes, J., Rosneck, J., & Gunstad, J. (2014) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2014.957167 · Cited by 16
Information management and reading habits of German diabetologists: a questionnaire survey
Trelle, S. (2002) · Diabetologia · doi:10.1007/s00125-002-0807-8 · Cited by 18
Establishing Quality Indicators and Implementation Priorities for Post‐Stroke Aphasia Services Through End‐User Involvement
Shrubsole, K., Stone, M., Cadilhac, D. A.-M., Kilkenny, M. F., Power, E., Lynch, E. A., Pierce, J. E., Copland, D. A., Godecke, E., Burton, B., et al. (2024) · Health Expectations · doi:10.1111/hex.14173 · Cited by 15
Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms
Vasudevan, R. S., Shin, J. H., Chopyk, J., Peacock, W. F., Torriani, F. J., Maisel, A. S., & Pride, D. T. (2020) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2019.10.010 · Cited by 21
“Hygiene rates are estimated to vary from 10% to 80%(18-22) when assessed by surveys, but the wide variation in these results likely reflects reporting biases.(23) Direct observational studies report much lower stethoscope hygiene, in the range of 11% to 16%.”
Background
Prescriber adherence to guidelines for chronic noncancer pain management with opioids: Systematic review and meta-analysis.
Hossain, M., Asamoah-Boaheng, M., Badejo, O. A., Bell, L., Buckley, N., Busse, J., Campbell, T., Corace, K., Cooper, L., Flusk, D., et al. (2020) · Health Psychology · doi:10.1037/hea0000830 · Cited by 15
Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men
Payne, S., Fowler, S., & Mundy, A. (2019) · BJU International · doi:10.1111/bju.14897 · Cited by 15
Computer-Facilitated 5A’s for Smoking Cessation: A Randomized Trial of Technology to Promote Provider Adherence
Satterfield, J. M., Gregorich, S. E., Kalkhoran, S. M., Lum, P. J., Bloome, J., Alvarado, N., Muñoz, R., & Vijayaraghavan, M. (2018) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.04.009 · Cited by 15
“42,43 Chart reviews have been seen as the least reliable given inconsistencies in charting, which often underestimate provider behaviors.”
Background
Is mobile phone radiation genotoxic? An analysis of micronucleus frequency in exfoliated buccal cells.
de Oliveira, F. M. D., Carmona, A. M., & Ladeira, C. (2017) · Mutation research · doi:10.1016/j.mrgentox.2017.08.001 · Cited by 15
Knowledge, attitude and tuberculosis infection control practice among healthcare workers in DOTS centres in Lagos, Nigeria
Ekuma, A., & Oridota, E. S. (2016) · International Journal of Infection Control · doi:10.3396/ijic.v12i4.16275 · Cited by 15
Prescribing of FDA-approved and compounded hormone therapy differs by specialty
Constantine, G., Archer, D., Graham, S., Bernick, B., & Mirkin, S. (2016) · Menopause · doi:10.1097/gme.0000000000000683 · Cited by 15
Addressing Disparities in Stroke Prevention for Atrial Fibrillation
Karcher, R. B., Berman, A. E., Gross, H., Hess, D. C., Jauch, E. C., Viser, P. E., Solenski, N. J., & Wolf, A. M. D. (2015) · American Journal of Medical Quality · doi:10.1177/1062860615577971 · Cited by 13
“Although some evidence supports the reliability of physician self-report of patient care activities,(41) more evidence suggests that physicians overestimate attitudes and clinical behaviors viewed as desirable.(42) However, an overestimation of appropriate practices further supports the need for clinician education in…”
Result
Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation
Connell, L., McMahon, N. E., Tyson, S., Watkins, C., & Eng, J. (2016) · Physical Therapy · doi:10.2522/ptj.20150694 · Cited by 15
Impact of self-reported guideline compliance: Bloodstream infection prevention in a national collaborative
Hsu, Y., Weeks, K. R., Yang, T., Sawyer, M. D., & Marsteller, J. A. (2014) · American Journal of Infection Control · doi:10.1016/j.ajic.2014.05.010 · Cited by 16
Automatic eating detection using a proximity sensor
Bai, Y.-C., Jia, W.-Y., Mao, Z.-H., & Sun, M. (2014) · Northeast Bioengineering Conference · doi:10.1109/nebec.2014.6972716 · Cited by 15
“However, the commonly used self-report methods are both inconvenient and inaccurate [4].”
Method

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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