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Research article
Xing-huan Wang
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4725-9581
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Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.
Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).
Results: The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation.
There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043).
Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.
Keywords
guideline, adherence, implementation, barriers
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
Additional file 1. the survey questionnaire
- Additionalfile2.docx
Additional file 2. table of Knowledge scores of key methodology for developing guidelines
- Additionalfile3.docx
Additional file 3. table of Enablers for guideline implementation in all respondents
- Additionalfile4.doc
Additional file 4. STROBE Statement—checklist of items that should be included in reports of observational studies
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CURRENT STATUS: Published
View the published article at BMC Medical Informatics and Decision Making.
Version 3
Posted 07 Jan, 2021
No community comments so far
Submission checks complete
On 25 Dec, 2020
Editorial decision: Accept
On 21 Dec, 2020
Version (no preprint)
Posted 14 Dec, 2020
Editorial decision: Minor revision
On 14 Dec, 2020
Editor assigned
On 08 Dec, 2020
Submission checks complete
On 08 Dec, 2020
Editor invited
On 08 Dec, 2020
This version was not preprinted
No comments provided
Editorial decision: Minor revision
On 17 Nov, 2020
Review #1 received
Received 20 Oct, 2020
Reviewer #1 agreed
On 30 Sep, 2020
Editor assigned
On 28 Sep, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Submission checks complete
On 27 Sep, 2020
Editor invited
On 27 Sep, 2020
No comments provided
Editorial decision: Major revision
On 25 Aug, 2020
Review #2 received
Received 19 Aug, 2020
Reviewer #2 agreed
On 27 Jul, 2020
Review #1 received
Received 23 Jul, 2020
Reviewers invited
Invitations sent on 23 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Editor assigned
On 22 Jul, 2020
Submission checks complete
On 02 Jul, 2020
Editor invited
On 02 Jul, 2020
First submitted
On 24 Jun, 2020
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Subject Areas
Medical Informatics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Medical Informatics and Decision Making.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Xing-huan Wang
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4725-9581
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Medical Informatics and Decision Making.
Version 3
Posted 07 Jan, 2021
No community comments so far
Submission checks complete
On 25 Dec, 2020
Editorial decision: Accept
On 21 Dec, 2020
Version (no preprint)
Posted 14 Dec, 2020
Editorial decision: Minor revision
On 14 Dec, 2020
Editor assigned
On 08 Dec, 2020
Submission checks complete
On 08 Dec, 2020
Editor invited
On 08 Dec, 2020
This version was not preprinted
No comments provided
Editorial decision: Minor revision
On 17 Nov, 2020
Review #1 received
Received 20 Oct, 2020
Reviewer #1 agreed
On 30 Sep, 2020
Editor assigned
On 28 Sep, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Submission checks complete
On 27 Sep, 2020
Editor invited
On 27 Sep, 2020
No comments provided
Editorial decision: Major revision
On 25 Aug, 2020
Review #2 received
Received 19 Aug, 2020
Reviewer #2 agreed
On 27 Jul, 2020
Review #1 received
Received 23 Jul, 2020
Reviewers invited
Invitations sent on 23 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Editor assigned
On 22 Jul, 2020
Submission checks complete
On 02 Jul, 2020
Editor invited
On 02 Jul, 2020
First submitted
On 24 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Medical Informatics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Medical Informatics and Decision Making.
Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.
Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).
Results: The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation.
There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043).
Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
Additional file 1. the survey questionnaire
- Additionalfile2.docx
Additional file 2. table of Knowledge scores of key methodology for developing guidelines
- Additionalfile3.docx
Additional file 3. table of Enablers for guideline implementation in all respondents
- Additionalfile4.doc
Additional file 4. STROBE Statement—checklist of items that should be included in reports of observational studies
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