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Evidence of self-report bias in assessing adherence to guidelines
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.130,131,133,134”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [133]
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“In particular, guideline adherence has been described to be overestimated in surveys designed to assess the quality of clinical care, at least in part due to social desirability bias [25].”
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“In contrast, traditional survey data can be time-consuming to collect and suffers from response bias 20 .”
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Metadata
- Authors
- Adams, A., Soumerai, S., Lomas, J., & Ross-Degnan, D.
- Affiliations
- Harvard University (US)
- Canadian Foundation for Healthcare Improvement (CA)
- 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
- 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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