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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Puschnerus, C., Eckhardt, G., Elliott, J., & Möller, D. (2024) · physioscience · doi:10.1055/a-2350-3628
“Nevertheless, the reliability of self-assessments of guideline adherence is generally considered to be lower than that of triangulated assessment methods [46, 49], such as the observation of clinical applications or the evaluation of documentation [46, 47].”
How Physicians Tackle Internet-Misinformed Patients: Going Beyond Traditional Patient-Centered Communication – A Study Protocol [Letter]
Gosrani, R., & Hang, M. (2023) · Advances in Medical Education and Practice · doi:10.2147/amep.s441807
A Snapshot of Hip and Knee Replacement Rehabilitation Care Across Canada: A Cross-Sectional Survey Using an Online Clinician Quality Indicator Questionnaire
Westby, M. D., Lalande, J.-F., Koehn, C. L., & Johal, N. (2023) · Physiotherapy Canada · doi:10.3138/ptc-2022-0083 · Cited by 2
Proprioception assessment in stroke rehabilitation: A survey of Australian physiotherapists and occupational therapists
Fisher, G., de Oliveira, C. Q., Rochette, A., Gandevia, S., & Kennedy, D. S. (2022) · Physiotherapy Practice and Research · doi:10.3233/ppr-210597
The effectiveness of PROMISE minimal smoking cessation intervention strategy to improve the adherence to smoking cessation counselling during pregnancy: A stepped-wedge cluster randomized controlled trial.
Bommelé, J., Springvloet, L., Abouri, N., Djoyoadhiningrat-Hol, K., van Laar, M. V., & Blankers, M. (2022) · Midwifery · doi:10.1016/j.midw.2022.103364
¿Cómo diagnosticamos la diverticulitis aguda? Resultados de una encuesta nacional sobre el papel de las técnicas de imagen
Roson, N., Antolín, A., Torregrosa, A., Gutiérrez, S. P., Cano, M. L., & Badia, J. M. (2022) · Radiología · doi:10.1016/j.rx.2022.02.009
Assessing pharmacists’ knowledge and compliance with narcotic inventory management using a computer-based educational platform
Hussein, R. N., Killeen, R. M., He, Z., & Grindrod, K. (2021) · International Journal of Pharmacy Practice · doi:10.1093/ijpp/riab013 · Cited by 1
Implementation of Tuberculosis Infection Control Practices in Tuberculosis Diagnostic and Treatment Health Facilities in Kampala District, Uganda, August 2015
Tugumisirize, D., Turyahabwe, S., Bulage, L., Muyanja, S. Z., Majwala, R., Kakinda, M., Muchuro, S., Nyombi, A., Nsawotebba, A., Mujuni, D., et al. (2020) · medRxiv · doi:10.1101/2020.07.14.20119214
“This discrepancy between reported and observed measures also highlights the weakness of self-reports [22].”
Result
Bedside Treatment Decisions: An Evaluation of the Factors Physicians Take into Consideration When Making Complex Rationing Decisions
Trarbach, J., Schosser, S., & Vogt, B. (2020) · Journal of Medical Psychology · doi:10.3233/jmp-170005
“Based on expectations of social desirability [11], one could argue that this result is a little surprising and that attention, in fact, was spread quite differently.”
Background
Evidence-Based Medicine in Neurosurgery—Other Side of the Coin?
Wani, A., & Sarmast, A. (2019) · Indian Journal of Neurosurgery · doi:10.1055/s-0039-1688729
Fragile, please handle with care : understanding and supporting professionals' response to suspicions of child abuse and neglect
Konijnendijk, A. (2018) · doi:10.3990/1.9789036545044
Is clinical pre-test probability assessment for venous thromboembolism underused?
Lange, N. F., Stalder, O., & Aujesky, D. (2017) · Thrombosis Research · doi:10.1016/j.thromres.2017.04.015
“While studies based on self-reported data tend to overestimate the use of clinical prediction rules [10], studies based on chart review, such as ours,may have the opposite effect.”
Rapid Synthesis: Key Features and Effects of Educational Approaches to Improve Clinical Performance
Wilson, M. G., & Guta, A. (2016) · MacSphere (McMaster University) · doi:10.71548/3020
“, Adams and colleagues observed that healthcare professionals often overestimated their performance by around 20% to 30%) (27)”
Neuropsychiatry residents’ attitudes and perceptions regarding evidence-based medicine: a mixed-methods study
Kim, Y., Chung, S.-Y., & Cho, S.-H. (2015) · Oriental Pharmacy and Experimental Medicine · doi:10.1007/s13596-015-0210-x
“As a self-reported adherence to guidelines may not correlate well with their objective usage rate (Adams et al. 1999), it is assumed that the actual evidence-utilization of both the NP residents and other respondents are lower than what was reported.”
Clinical commentary on collinge et Al.(1.).
Yeung, E. (2013) · Physiotherapy Canada. Physiothérapie Canada · doi:10.3138/ptc.2012-33bc-cc
Improving Outcomes Through Quality Improvement
Charlton, R., Platzker, A. C. G., & Margetis, M. F. (2011) · ICAN Infant Child & Adolescent Nutrition · doi:10.1177/1941406411402326
Sexual Abstinence Counseling among Trainees and Teachers in a Catholic Pediatric Residency Program: Clinical Education within the Context of Conflicting Ideologies
Fernandes, A. K. (2011) · doi:10.1007/bf03355140
Was ist Leitlinienkonformität? Theoretische und methodische Überlegungen zu einem aktuellem Konzept der Versorgungsforschung und Qualitätssicherung
Hasenbein, U., & Wallesch, C. (2007) · doi:10.1055/s-2007-985388
L’évaluation des pratiques cliniques : quels modes de recueil des données et à partir de quelles sources d’information?
Touzet, S., Schott, A., Ploin, D., Maujean, G., & Colin, C. (2006) · Revue d Épidémiologie et de Santé Publique · doi:10.1016/s0398-7620(06)76718-9 · Cited by 2
Analytic synthesis of the effect of foot orthoses on gait biomechanics and pain in patients with rheumatoid arthritis: an explorative experimental and clinical approach
Simonsen, M. (2020) · doi:10.5278/vbn.phd.med.00141
“These data sources have a poor accuracy due to recall and response bias (Adams et al., 1999; Sackett, 1979).”
Background
Towards a person-centred approach for older people with intellectual disabilities: the use and effect of Dementia Care Mapping
Schaap, F. D. (2019) · doi:10.33612/diss.102982781
Employing E-Learning to promote smoking cessation care
de Ruijter, D. (2018) · Research Publications (Maastricht University) · doi:10.26481/dis.20181107dr
AIN’T I BLACK ENOUGH?: ANXIETY RELATED TO THE QUESTIONING OF ONE’S GROUP MEMBERSHIP
Stith, M. (2017) · doi:10.25772/4qps-9832
Examining Biological and Psychological Variables in Hypertensive Disorders of Pregnancy
Kehler, S. A. (2017) · doi:10.13023/etd.2017.152
“Social desirability bias occurs when an individual reports the socially desirable behavior when questioned (Adams et al., 1999).”
Background
Fieber: Thesen innerhalb der Anthroposophischen Medizin und ihre wissenschaftliche Validität
Martín, D. (2017) · Der Merkurstab · doi:10.14271/dms-20844-de

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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